Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 4480 | CA |
NPI | 1003454737 |
---|---|
Provider Name | Renee Lin |
First Address | El Monte, CA 91732-2554 |
Second Address | Glendale, CA 91201-2803 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/12/2019 |
Last Update Date | 12/12/2019 |