Healthcare Provider Details

I. General information

NPI: 1013346139
Provider Name (Legal Business Name): LINDA KOCHAN OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2013
Last Update Date: 11/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25107 SOUTHPORT ST
LAGUNA HILLS CA
92653-4922
US

IV. Provider business mailing address

25107 SOUTHPORT ST
LAGUNA HILLS CA
92653-4922
US

V. Phone/Fax

Practice location:
  • Phone: 949-597-9436
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2368
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number2368
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number2368
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number2368
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: