Healthcare Provider Details

I. General information

NPI: 1275991010
Provider Name (Legal Business Name): MICHAEL JOSEPH NADER O.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2016
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16030 VENTURA BLVD #100
ENCINO CA
91436-2754
US

IV. Provider business mailing address

16030 VENTURA BLVD #100
ENCINO CA
91436-2754
US

V. Phone/Fax

Practice location:
  • Phone: 818-981-3688
  • Fax: 818-981-3588
Mailing address:
  • Phone: 818-981-3688
  • Fax: 818-981-3588

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT17557
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: