Individual
YAISHA DAMEKA BUSH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
725 GROVE ST, HEALDSBURG, CA 95448-4756
(707) 433-4877
Mailing address
3409 LAKE PARK CT, SANTA ROSA, CA 95403-5726
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
5025
CA
Other
Enumeration date
09/28/2021
Last updated
09/28/2021
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