Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | OT3904 |
NPI | 1073912598 |
---|---|
Provider Name | Mrs. Gail Bagby |
First Address | Sacramento, CA 95823-5410 |
Second Address | Sacramento, CA 95823-5410 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2014 |
Last Update Date | 21/08/2014 |