MEDICARE: HRANT AGAKHANYAN OTD, 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	25675	CA

General Provider Information

NPI Number	:	1659142032
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HRANT AGAKHANYAN OTD, OTR

Provider Business Mailing Address
First Line	:	512 W STOCKER ST APT 1
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91202-3523
Country	:	US
Telephone Number	:	818-929-6168
Fax Number	:

Provider Business Practice Location Address
First Line	:	1055 N KINGSLEY DR
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90029-1207
Country	:	US
Telephone Number	:	323-661-1128
Fax Number	:

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

Provider Enumeration Date	:	01/12/2024
Last Update Date	:	01/12/2024

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