Individual
MIA BROOKE FULLEYLOVE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2208 W SUNNYSIDE AVE, VISALIA, CA 93277-7295
(559) 627-3274
Mailing address
2208 W SUNNYSIDE AVE, VISALIA, CA 93277-7295
(559) 627-3274
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
7192
CA
Other
Enumeration date
10/08/2025
Last updated
10/08/2025
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