Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225000000X | Orthotic Fitter | OT2084 | CA |
N | 225XE0001X | Environmental Modification | OT2084 | CA |
N | 2251E1200X | Ergonomics | OT2084 | CA |
N | 225XE1200X | Ergonomics | OT2084 | CA |
N | 225XH1200X | Occupational Therapist - Hand | OT2084 | CA |
N | 225XP0200X | Occupational Therapist - Pediatrics | OT2084 | CA |
Y | 225XR0403X | Driving and Community Mobility | OT2084 | CA |
NPI | 1780703553 |
---|---|
Provider Name | Ms. Lula Marie Capuchino |
First Address | Folsom, CA 95763-6268 |
Second Address | Sacramento, CA 95821-5309 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2007 |
Last Update Date | 10/10/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
OT0020840 | BLUE SHIELD PIN (01) | CA |