Provider Demographics
NPI:1356579908
Name:TODRANK, MYRA JOAN (OT)
Entity type:Individual
Prefix:
First Name:MYRA
Middle Name:JOAN
Last Name:TODRANK
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 E BIDWELL ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-3565
Mailing Address - Country:US
Mailing Address - Phone:916-983-5915
Mailing Address - Fax:916-983-5925
Practice Address - Street 1:101 E NATOMA ST
Practice Address - Street 2:SUITE 1
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-2700
Practice Address - Country:US
Practice Address - Phone:916-353-5295
Practice Address - Fax:916-353-5297
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-22
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA117225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist