Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | 9543 | CA |
NPI | 1184866899 |
---|---|
Provider Name | Mrs. Kim Koehler Russell |
First Address | La Jolla, CA 92037 |
Second Address | San Diego, CA 92123-1951 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2009 |
Last Update Date | 26/03/2009 |