Individual
TRACEY L AIRTH-EDBLOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L, CHT
Contact information
Practice address
226 WELLER ST, PETALUMA, CA 94952-3136
(707) 762-7678
(707) 762-7679
Mailing address
8 PACIFIC DR, NOVATO, CA 94949-5479
(415) 382-8202
(415) 382-8212
Taxonomy
Speciality
Code
Description
License number
State
225XH1200X
Hand Occupational Therapist
Primary
OT345
CA
Other
Enumeration date
06/11/2008
Last updated
06/11/2008
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