Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 9263 | CA |
N | 225XL0004X | Low Vision | 9263 | CA |
NPI | 1205243185 |
---|---|
Provider Name | Toni Boom |
First Address | Sacramento, CA 95811-7112 |
Second Address | Sacramento, CA 95811-7112 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2014 |
Last Update Date | 10/06/2015 |