Individual
NICOLE JOED SANTIAGO DE JESUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
1628 B ST, HAYWARD, CA 94541-3020
(510) 582-4636
Mailing address
9091 HASTINGS BEACH BLVD, ORLANDO, FL 32829-8811
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA3784
CA
Other
Enumeration date
06/20/2017
Last updated
06/20/2017
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