Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | 1874 | CA |
NPI | 1124267034 |
---|---|
Provider Name | Mrs. Adrienne Ann Tesarek |
First Address | Encino, CA 91316-3209 |
Second Address | San Diego, CA 92103 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/02/2009 |
Last Update Date | 23/12/2020 |