Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 1505 | CA |
NPI | 1033631676 |
---|---|
Provider Name | Nina Lao |
First Address | Alameda, CA 94502-6817 |
Second Address | Oakland, CA 94609-1809 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2017 |
Last Update Date | 15/07/2017 |