Healthcare Provider Details

I. General information

NPI: 1669137642
Provider Name (Legal Business Name): LAYNE BERTHOUD MA, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2021
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 W OAK ST
BURBANK CA
91505-3514
US

IV. Provider business mailing address

2656 MAYFIELD AVE
LA CRESCENTA CA
91214-3814
US

V. Phone/Fax

Practice location:
  • Phone: 818-558-5522
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number22958
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: