Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | 707 | CA |
NPI | 1255315966 |
---|---|
Provider Name | Mrs. Lisa Barry Gofberg |
First Address | Thousand Oaks, CA 91360-3951 |
Second Address | Thousand Oaks, CA 91360-3951 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2005 |
Last Update Date | 24/09/2008 |