Healthcare Provider Details

I. General information

NPI: 1306305131
Provider Name (Legal Business Name): JUDY SU-LE OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2019
Last Update Date: 03/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8501 WILSHIRE BLVD STE 336
BEVERLY HILLS CA
90211-3134
US

IV. Provider business mailing address

13761 LA PAT PL APT B
WESTMINSTER CA
92683-8814
US

V. Phone/Fax

Practice location:
  • Phone: 310-659-9511
  • Fax:
Mailing address:
  • Phone: 714-725-2374
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number19647
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: