Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103K00000X | Behavior Analyst | 1-15-19449 | CA |
Y | 225X00000X | Occupational Therapist | OT9265 | CA |
N | 225XP0200X | Occupational Therapist - Pediatrics | OT-9265 | CA |
NPI | 1043459340 |
---|---|
Provider Name | Ms. Cynthia June Conway |
First Address | Simi Valley, CA 93065-6200 |
Second Address | Simi Valley, CA 93065-6200 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/02/2009 |
Last Update Date | 29/07/2021 |