Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | OT 10356 | CA |
NPI | 1902332554 |
---|---|
Provider Name | Mrs. Dana Patikamanant |
First Address | Downey, CA 90242-3456 |
Second Address | Downey, CA 90242-3456 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2017 |
Last Update Date | 02/05/2017 |