Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | 13347 | CA |
Y | 225XP0200X | Occupational Therapist - Pediatrics | 13347 | CA |
NPI | 1063828846 |
---|---|
Provider Name | Mrs. Melody Fabian |
First Address | San Jose, CA 95129-4934 |
Second Address | San Jose, CA 95129-4934 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2014 |
Last Update Date | 01/07/2014 |