Healthcare Provider Details

I. General information

NPI: 1124863238
Provider Name (Legal Business Name): ANGELA GALSTYAN OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2024
Last Update Date: 06/28/2024
Certification Date: 06/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 ARDEN AVE STE 14
GLENDALE CA
91203-1159
US

IV. Provider business mailing address

221 E LEXINGTON DR APT 208
GLENDALE CA
91206-3504
US

V. Phone/Fax

Practice location:
  • Phone: 818-434-5120
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number23315
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: