Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 6129 | CA |
N | 225XP0200X | Occupational Therapist - Pediatrics | 6129 | CA |
NPI | 1033649553 |
---|---|
Provider Name | Stephanie Nicole Thorp |
First Address | Newport Beach, CA 92663-4813 |
Second Address | Newport Beach, CA 92663-4813 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2017 |
Last Update Date | 18/06/2017 |