Healthcare Provider Details

I. General information

NPI: 1407445539
Provider Name (Legal Business Name): SUSAN YI OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2021
Last Update Date: 01/13/2021
Certification Date: 01/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17042 BELLFLOWER BLVD
BELLFLOWER CA
90706-5950
US

IV. Provider business mailing address

817 W BEVERLY BLVD STE 201
MONTEBELLO CA
90640-4265
US

V. Phone/Fax

Practice location:
  • Phone: 562-991-1324
  • Fax:
Mailing address:
  • Phone: 562-927-5820
  • Fax: 563-684-0102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number22009
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: