Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 1750 | CA |
NPI | 1023408143 |
---|---|
Provider Name | Tracy Bryant |
First Address | El Cajon, CA 92020-2178 |
Second Address | El Cajon, CA 92020-2178 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/01/2015 |
Last Update Date | 27/01/2015 |