Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | 5647 | CA |
NPI | 1417020306 |
---|---|
Provider Name | Mrs. Patricia Fong Chan |
First Address | Redwood City, CA 94063-2037 |
Second Address | Redwood City, CA 94063-2037 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2006 |
Last Update Date | 03/01/2022 |