| NPI | 1316363781 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHANTEL ROSE POWELL Owner 760-685-7694 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: CA 10089) |
| Additional Taxonomies | 225XP0200X Occupational Therapist, Pediatrics (Licence: CA 10089) |
| Enumeration Date | 2014-03-10 |
| Last Update Date | 2018-03-13 |