Individual
MARYLEE BANZON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, OTR/L
Contact information
Practice address
29516 KOHOUTEK WAY, UNION CITY, CA 94587-1221
(510) 441-8240
Mailing address
1719 GARIBALDI DR, MANTECA, CA 95336-7088
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
16033
CA
Other
Enumeration date
10/12/2018
Last updated
10/12/2018
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