Individual
AUDREY JOHANNA Y TAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
517 S A ST, MADERA, CA 93638-3806
(714) 390-8761
Mailing address
3149 ANTONIO AVE, CLOVIS, CA 93619-8907
(714) 390-8761
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
11003
CA
Other
Enumeration date
02/01/2023
Last updated
02/01/2023
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