Individual
ETHEL-GRACE VICTORIA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
1150 TILTON DR, SUNNYVALE, CA 94087-2440
(916) 300-7854
Mailing address
1226 ELM LAKE CT, SAN JOSE, CA 95131-3900
(408) 313-0175
Taxonomy
Speciality
Code
Description
License number
State
225XP0019X
Physical Rehabilitation Occupational Therapist
Primary
4017
CA
Other
Enumeration date
07/27/2010
Last updated
07/27/2010
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