Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 15592 | CA |
N | 225XG0600X | Occupational Therapist - Gerontology | 15592 | CA |
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 15592 | CA |
NPI | 1922570225 |
---|---|
Provider Name | Stacey Ann Seidman |
First Address | Simi Valley, CA 93065-6603 |
Second Address | Ventura, CA 93003-6523 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/12/2018 |
Last Update Date | 26/12/2018 |