Healthcare Provider Details

I. General information

NPI: 1366061384
Provider Name (Legal Business Name): APRIL GABRIELLA WASJUTIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2020
Last Update Date: 04/09/2020
Certification Date: 04/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4380 MITCHELL RD
EUREKA CA
95503-9715
US

IV. Provider business mailing address

4380 MITCHELL RD
EUREKA CA
95503-9715
US

V. Phone/Fax

Practice location:
  • Phone: 805-455-7780
  • Fax:
Mailing address:
  • Phone: 805-455-7780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT15904
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: