Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | PT22836 | CA |
NPI | 1134464654 |
---|---|
Provider Name | Theresa J O'hern |
First Address | Aliso Viejo, CA 92656-2211 |
Second Address | Santa Ana, CA 92701-4134 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/12/2012 |
Last Update Date | 10/12/2012 |