Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | 13 | CA |
NPI | 1154446771 |
---|---|
Provider Name | Ms. Anne Marie Fultz |
First Address | Modesto, CA 95358-8595 |
Second Address | Modesto, CA 95350-6131 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2007 |
Last Update Date | 08/07/2007 |