Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | OT9036 | CA |
NPI | 1588152235 |
---|---|
Provider Name | Rebecca Luckett Belsanti |
First Address | Los Angeles, CA 90048-4621 |
Second Address | Los Angeles, CA 90048-4621 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/04/2018 |
Last Update Date | 27/04/2018 |