Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 1867 | CA |
NPI | 1053652701 |
---|---|
Provider Name | Mrs. Penelope Jo Erickson |
First Address | San Diego, CA 92130-5789 |
Second Address | Simi Valley, CA 93065-6560 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/03/2013 |
Last Update Date | 05/03/2013 |