Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 13650 | CA |
NPI | 1770971665 |
---|---|
Provider Name | Phyllis Karmele |
First Address | Oakland, CA 94610-2901 |
Second Address | Oakland, CA 94610-2901 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/12/2014 |
Last Update Date | 31/12/2014 |