Individual
JESSE MCCORMACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1650 S AMPHLETT BLVD STE 108, SAN MATEO, CA 94402-2514
(650) 638-9142
(650) 638-9141
Mailing address
1650 S AMPHLETT BLVD STE 108, SAN MATEO, CA 94402-2514
(650) 638-9142
(650) 638-9141
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
LP 1411
CA
Other
Enumeration date
04/03/2014
Last updated
04/03/2014
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