Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | 5706 | CA |
NPI | 1033234505 |
---|---|
Provider Name | Mrs. Lisba Probeck Brandt |
First Address | San Mateo, CA 94403-3206 |
Second Address | San Mateo, CA 94403-5106 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2007 |
Last Update Date | 08/07/2007 |