MEDICARE: DANIEL EDWARD LUO OTD, OTR/L, HTC

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	225XH1200X	Hand Occupational Therapist	18081	CA

General Provider Information

NPI Number	:	1689142309
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL EDWARD LUO OTD, OTR/L, HTC

Provider Business Mailing Address
First Line	:	2001 WILSHIRE BLVD STE 310
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90403-5683
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2001 WILSHIRE BLVD STE 310
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90403-5683
Country	:	US
Telephone Number	:	310-829-3320
Fax Number	:

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

Provider Enumeration Date	:	11/12/2018
Last Update Date	:	11/12/2018

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