Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics |
NPI | 1063706687 |
---|---|
Provider Name | Ms. Michele Heather Gerrity |
First Address | Fullerton, CA 92832-3038 |
Second Address | Fullerton, CA 92832-3038 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2011 |
Last Update Date | 31/05/2011 |