Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | 14414 | CA |
Y | 225XH1200X | Occupational Therapist - Hand | 14414 | CA |
NPI | 1235544354 |
---|---|
Provider Name | Nicole Reaves |
First Address | Newport Beach, CA 92660-7503 |
Second Address | Anaheim, CA 92807 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2014 |
Last Update Date | 18/07/2018 |