Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | 00002991 | WA |
NPI | 1033128236 |
---|---|
Provider Name | Mrs. Mary Charlene Guardia |
First Address | Gig Harbor, WA 98335-6308 |
Second Address | Gig Harbor, WA 98335-6498 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2006 |
Last Update Date | 05/12/2016 |