Individual
CELICA KIDO EAGLESON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
947 3RD ST, SANTA MONICA, CA 90403-2508
(310) 430-0597
Mailing address
2125 21ST ST, SANTA MONICA, CA 90405-1705
(310) 430-0597
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
3247
CA
Other
Enumeration date
10/20/2017
Last updated
10/20/2017
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