Individual
TERA THORESON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2682 SANTA ANA AVE APT 4, COSTA MESA, CA 92627-6623
(949) 579-0424
Mailing address
2682 SANTA ANA AVE APT 4, COSTA MESA, CA 92627-6623
(949) 579-0424
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
3449
CA
Other
Enumeration date
12/19/2018
Last updated
12/19/2018
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