Healthcare Provider Details

I. General information

NPI: 1578384004
Provider Name (Legal Business Name): EMILY MADISON KRAKOWER OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2024
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

943 N GRAND AVE
COVINA CA
91724-2046
US

IV. Provider business mailing address

2500 N LA CAPELLA CT
ORANGE CA
92867-1922
US

V. Phone/Fax

Practice location:
  • Phone: 626-671-6100
  • Fax:
Mailing address:
  • Phone: 805-791-1471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: