Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 3027 | CA |
NPI | 1033361753 |
---|---|
Provider Name | Shannon Ijams |
First Address | Laguna Hills, CA 92653-1447 |
Second Address | Laguna Hills, CA 92653-1447 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2008 |
Last Update Date | 13/10/2008 |