MEDICARE: IRINE SOLTANOVICH OTR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	OT3451	CA

General Provider Information

NPI Number	:	1073966131
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IRINE SOLTANOVICH OTR

Provider Business Mailing Address
First Line	:	5439 BEELER AVE
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91367-5707
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7188 W SUNSET BLVD
Second Line	:	SUITE #200
City	:	LOS ANGELES
State	:	CA
Zip	:	90046-4400
Country	:	US
Telephone Number	:	323-436-0006
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/13/2016
Last Update Date	:	07/14/2016

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