Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | 509 | CA |
N | 225XR0403X | Driving and Community Mobility | 509 | CA |
NPI | 1245363704 |
---|---|
Provider Name | Sandi Cullinen |
First Address | Cotati, CA 94931-3051 |
Second Address | Cotati, CA 94931-3051 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/03/2007 |
Last Update Date | 20/05/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
NONE | DEPT. OF LABOR (01) | CA |
OT005080 | BLUE SHIELD (01) | CA |