Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 13060 | CA |
NPI | 1003272717 |
---|---|
Provider Name | Mrs. Jamie Stanners |
First Address | Fresno, CA 93711-3334 |
Second Address | Fresno, CA 93711-3334 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2016 |
Last Update Date | 01/11/2016 |