Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | 105102 | MN |
Y | 225XH1200X | Occupational Therapist - Hand | OT19430 |
NPI | 1154879146 |
---|---|
Provider Name | Ms. Halie Sperry |
First Address | San Diego, CA 92130-2226 |
Second Address | San Diego, CA 92130 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/09/2016 |
Last Update Date | 08/04/2021 |