Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | 4695 | CA |
NPI | 1124249057 |
---|---|
Provider Name | Ms. Mary Madeline Connolly |
First Address | El Cajon, CA 92019 |
Second Address | Chula Vista, CA 91910 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2007 |
Last Update Date | 08/07/2007 |