Healthcare Provider Details

I. General information

NPI: 1316925282
Provider Name (Legal Business Name): MANUEL BOUFFARD OTR CHT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2006
Last Update Date: 11/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4010 ORANGE AVE
LONG BEACH CA
90807-2374
US

IV. Provider business mailing address

4010 ORANGE AVE
LONG BEACH CA
90807-3717
US

V. Phone/Fax

Practice location:
  • Phone: 562-428-3556
  • Fax: 562-428-3621
Mailing address:
  • Phone: 562-428-3556
  • Fax: 562-428-3621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License Number00978
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number00978
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number00978
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code225XE1200X
TaxonomyErgonomics Occupational Therapist
License NumberOT00978
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number00978
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code225XH1300X
TaxonomyHuman Factors Occupational Therapist
License Number00978
License Number StateCA
# 7
Primary TaxonomyN
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License Number00978
License Number StateCA
# 8
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number00978
License Number StateCA
# 9
Primary TaxonomyN
Taxonomy Code225XR0403X
TaxonomyDriving and Community Mobility Occupational Therapist
License Number00978
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: