MEDICARE: MR. LARRY DEAN NAVARRO C.O.T.A./C

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	224Z00000X	Occupational Therapy Assistant	OTA454	CA

General Provider Information

NPI Number	:	1942468251
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LARRY DEAN NAVARRO C.O.T.A./C

Provider Business Mailing Address
First Line	:	200 W WARDLOW RD
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90807-4429
Country	:	US
Telephone Number	:	562-988-8031
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 W WARDLOW RD
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90807-4429
Country	:	US
Telephone Number	:	562-988-8031
Fax Number	:

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

Provider Enumeration Date	:	05/23/2008
Last Update Date	:	05/27/2008

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