Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | OT14642 | CA |
Y | 225XM0800X | Mental Health | OT14642 | CA |
NPI | 1043607393 |
---|---|
Provider Name | Valerie Estioko |
First Address | Redwood City, CA 94062-3803 |
Second Address | San Mateo, CA 94403-4324 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2015 |
Last Update Date | 23/04/2015 |