Individual
TAMI RENEE ETHERIDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
8717 VENICE BLVD, LOS ANGELES, CA 90034-3216
(310) 337-7115
Mailing address
8717 VENICE BLVD, LOS ANGELES, CA 90034-3216
(310) 337-7115
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
11583
CA
Other
Enumeration date
01/27/2011
Last updated
01/27/2011
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