Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1023656071 |
---|---|
Provider Name | Olivia Morris |
First Address | Van Nuys, CA 91406-3782 |
Second Address | Van Nuys, CA 91406-3782 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/12/2019 |
Last Update Date | 19/12/2019 |