Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | AT6447 | CA |
NPI | 1013091479 |
---|---|
Provider Name | Scott B Stuart |
First Address | Sacramento, CA 95865-5668 |
Second Address | Fairfield, CA 94534-9727 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2006 |
Last Update Date | 08/07/2007 |