Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OT 8425 | CA |
N | 2251E1200X | Ergonomics | OT 8425 | CA |
N | 225XE1200X | Ergonomics | OT 8425 | CA |
N | 225XH1200X | Occupational Therapist - Hand | OT8425 | CA |
N | 225XN1300X | Occupational Therapist - Neurorehabilitation | OT 8425 | CA |
NPI | 1881768224 |
---|---|
Provider Name | Mrs. Marilen Mamuyac Grimm |
First Address | Glendale, CA 91202-2813 |
Second Address | Glendale, CA 91202 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/11/2006 |
Last Update Date | 18/08/2010 |