Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 1211 | CA |
NPI | 1023306271 |
---|---|
Provider Name | Stacey Marie Vingerelli |
First Address | Fullerton, CA 92832-3038 |
Second Address | Fullerton, CA 92832-3038 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2011 |
Last Update Date | 20/07/2011 |