Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 18216 | CA |
NPI | 1013403120 |
---|---|
Provider Name | Trisha Jean Park |
First Address | Union City, CA 94587-1221 |
Second Address | Union City, CA 94587-1221 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2018 |
Last Update Date | 12/08/2020 |