Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 12392 | CA |
NPI | 1033514153 |
---|---|
Provider Name | Stacey Morikawa |
First Address | Los Angeles, CA 90033-5313 |
Second Address | Los Angeles, CA 90033-5313 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2014 |
Last Update Date | 31/10/2014 |