Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | ||
N | 225XF0002X | Feeding, Eating & Swallowing |
NPI | 1417249848 |
---|---|
Provider Name | Renee Graham |
First Address | Valencia, CA 91355-4023 |
Second Address | Valencia, CA 91355-4023 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2011 |
Last Update Date | 23/08/2016 |