MEDICARE: MS. LILAH SUSANNAH LARRABURE OTR/L

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	7778	CA

General Provider Information

NPI Number	:	1821567793
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LILAH SUSANNAH LARRABURE OTR/L

Provider Business Mailing Address
First Line	:	18311 SUMMER AVE
Second Line	:
City	:	ARTESIA
State	:	CA
Zip	:	90701-5526
Country	:	US
Telephone Number	:	310-502-5429
Fax Number	:

Provider Business Practice Location Address
First Line	:	3901 E 4TH ST
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90814-1632
Country	:	US
Telephone Number	:	562-434-8421
Fax Number	:

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

Provider Enumeration Date	:	11/20/2018
Last Update Date	:	11/20/2018

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