Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | 16193 | CA |
NPI | 1306380464 |
---|---|
Provider Name | Nicole Masters |
First Address | Temecula, CA 92590-5645 |
Second Address | Temecula, CA 92590-5645 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/12/2016 |
Last Update Date | 08/12/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
16193 | CALIFORNIA OT LICENSE (01) | CA |