Individual
EBONIE L CARLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
1470 CIVIC CT, SUITE 320, CONCORD, CA 94520
(925) 326-2211
Mailing address
1470 CIVIC CT, SUITE 320, CONCORD, CA 94520
(925) 326-2211
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT21551
CA
Other
Enumeration date
11/04/2020
Last updated
11/04/2020
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