Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 3688 | CA |
N | 225XF0002X | Feeding, Eating & Swallowing | 3688 | CA |
NPI | 1811270887 |
---|---|
Provider Name | Mrs. Janis Noda Ikeda |
First Address | San Jose, CA 95112-2367 |
Second Address | San Jose, CA 95112-2367 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2011 |
Last Update Date | 26/09/2011 |