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Individual

SHELLY MOURNING

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
13117 ENTREKEN AVE, SAN DIEGO, CA 92129-2303
(303) 882-7698
Mailing address
13117 ENTREKEN AVE, SAN DIEGO, CA 92129-2303
(303) 882-7698

Taxonomy

Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
11176
CA
225XP0200X
Pediatric Occupational Therapist
Primary
OT01365
RI

Other

Enumeration date
08/09/2013
Last updated
05/04/2015
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