Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 1070985 | CA |
NPI | 1003003567 |
---|---|
Provider Name | Ms. Brooke Hallie Redman |
First Address | San Diego, CA 92111-1318 |
Second Address | San Diego, CA 92111-1318 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/09/2007 |
Last Update Date | 31/01/2017 |