Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OT389 | CA |
N | 225XG0600X | Occupational Therapist - Gerontology | OT389 | CA |
N | 225XN1300X | Occupational Therapist - Neurorehabilitation | OT389 | CA |
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | OT389 | CA |
NPI | 1740666817 |
---|---|
Provider Name | Mrs. Ellen Bauer Hume |
First Address | Los Angeles, CA 90007-2846 |
Second Address | Lynwood, CA 90262-3625 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/07/2015 |
Last Update Date | 30/07/2015 |