Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | OT345 | CA |
NPI | 1053571307 |
---|---|
Provider Name | Tracey L Airth-Edblom |
First Address | Novato, CA 94949-5479 |
Second Address | Petaluma, CA 94952-3136 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2008 |
Last Update Date | 11/06/2008 |