Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 3995 | CA |
NPI | 1023292299 |
---|---|
Provider Name | Tamara Mangum |
First Address | Irvine, CA 92602-0938 |
Second Address | Irvine, CA 92606 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/12/2007 |
Last Update Date | 24/12/2007 |