Healthcare Provider Details

I. General information

NPI: 1629551916
Provider Name (Legal Business Name): CHRISTINE K CHANG OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2018
Last Update Date: 04/01/2020
Certification Date: 04/01/2020
Deactivation Date: 03/04/2020
Reactivation Date: 03/18/2020

III. Provider practice location address

500 W CENTRAL AVE STE B
BREA CA
92821-3036
US

IV. Provider business mailing address

31 ALEVERA ST
IRVINE CA
92618-7018
US

V. Phone/Fax

Practice location:
  • Phone: 714-529-5022
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number20691
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: