Healthcare Provider Details

I. General information

NPI: 1790099752
Provider Name (Legal Business Name): AKEMI NOELE MCNEIL MA, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AKEMI NOELE DAVIES OTR/L

II. Dates (important events)

Enumeration Date: 08/02/2010
Last Update Date: 03/21/2023
Certification Date: 03/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5762 BOLSA AVE SUITE 101
HUNTINGTON BEACH CA
92649-1172
US

IV. Provider business mailing address

5762 BOLSA AVE SUITE 101
HUNTINGTON BEACH CA
92649-1172
US

V. Phone/Fax

Practice location:
  • Phone: 714-292-2322
  • Fax: 714-866-4153
Mailing address:
  • Phone: 714-292-2322
  • Fax: 714-866-4153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number7905
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: