Healthcare Provider Details

I. General information

NPI: 1912304262
Provider Name (Legal Business Name): BOBBY WOODCOCK OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2014
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 KALMUS DR
COSTA MESA CA
92626-5922
US

IV. Provider business mailing address

200 KALMUS DR
COSTA MESA CA
92626-5922
US

V. Phone/Fax

Practice location:
  • Phone: 714-966-4000
  • Fax:
Mailing address:
  • Phone: 714-966-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number25214
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: