Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OT2716 | CA |
N | 225XH1200X | Occupational Therapist - Hand |
NPI | 1043567852 |
---|---|
Provider Name | Ms. Carla Suarez Reyes-Cuerva |
First Address | Fresno, CA 93711-6551 |
Second Address | Fresno, CA 93720-8009 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2012 |
Last Update Date | 10/08/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
OT2716 | CA BD OF OCCUPATIONAL THERAPY (01) | CA |