Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | OT3402 | CA |
NPI | 1023179256 |
---|---|
Provider Name | Mrs. Julie A. Gyoerkoe |
First Address | Oakland, CA 94611-5642 |
Second Address | Oakland, CA 94611-5642 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/12/2006 |
Last Update Date | 08/07/2007 |