Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | OT 6152 | CA |
NPI | 1164714333 |
---|---|
Provider Name | Mrs. Karen Solomon Persichetti |
First Address | Thousand Oaks, CA 91362-3163 |
Second Address | Thousand Oaks, CA 91362-3163 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/05/2011 |
Last Update Date | 06/05/2011 |