Healthcare Provider Details

I. General information

NPI: 1760872170
Provider Name (Legal Business Name): DAVID ECKHOUS OTR/L, CO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2015
Last Update Date: 01/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

759 HAVANA AVE
LONG BEACH CA
90804-4450
US

IV. Provider business mailing address

759 HAVANA AVE
LONG BEACH CA
90804-4450
US

V. Phone/Fax

Practice location:
  • Phone: 562-522-1344
  • Fax:
Mailing address:
  • Phone: 562-522-1344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Z00000X
TaxonomyOrthotist
License NumberCO1498
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT6746
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: