Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | 5317 | CA |
NPI | 1184899742 |
---|---|
Provider Name | Mrs. Jennifer Irene Mcdaniel |
First Address | Chico, CA 95926-7161 |
Second Address | Chico, CA 95926-7161 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2008 |
Last Update Date | 24/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5317 | CALIFORNIA BOARD OF CONSUMER AFFAIRS - OT LICENSE (01) | CA |