Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | 4654 | CA |
NPI | 1649433301 |
---|---|
Provider Name | Mrs. Vivienne Minesa Hendricks-Clark |
First Address | Manhattan Beach, CA 90266-5943 |
Second Address | Manhattan Beach, CA 90266-5943 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2008 |
Last Update Date | 02/07/2008 |