Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | 4202 | CA |
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 4202 | CA |
NPI | 1417400169 |
---|---|
Provider Name | Tara Mayer |
First Address | Chico, CA 95928-4144 |
Second Address | Omaha, NE 68144-2981 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2016 |
Last Update Date | 29/07/2016 |