Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | 2814 | CA |
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 2814 | CA |
NPI | 1013020973 |
---|---|
Provider Name | Ms. Tracy L West-Stallard |
First Address | Mammoth Lakes, CA 93546-2073 |
Second Address | Bishop, CA 93514-3415 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2006 |
Last Update Date | 11/02/2021 |