Individual
KRISTINE RYAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
12900B GARDEN GROVE BLVD STE 235, GARDEN GROVE, CA 92843-2027
(714) 750-9700
(714) 750-9797
Mailing address
PO BOX 1726, WESTMINSTER, CA 92684-1726
(714) 750-9700
(714) 750-9797
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
5521
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5521
STATE LICENSE
CA
Enumeration date
02/25/2021
Last updated
10/16/2024
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