Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 3360 | CA |
NPI | 1003273715 |
---|---|
Provider Name | Shannon Correa |
First Address | Hawthorne, CA 90250-5898 |
Second Address | Hawthorne, CA 90250-5898 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2016 |
Last Update Date | 26/01/2016 |