Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | OT 2113 | CA |
Y | 225XH1200X | Occupational Therapist - Hand | OT 2113 | CA |
NPI | 1265639165 |
---|---|
Provider Name | Susan H. Kornreich |
First Address | Santa Ana, CA 92701 |
Second Address | Santa Ana, CA 92701 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2007 |
Last Update Date | 28/07/2009 |