Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 20602 | CA |
NPI | 1003304809 |
---|---|
Provider Name | Sara Aileen Harrison |
First Address | Long Beach, CA 90810-1870 |
Second Address | Long Beach, CA 90810-1870 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2018 |
Last Update Date | 14/11/2019 |