Healthcare Provider Details

I. General information

NPI: 1790647154
Provider Name (Legal Business Name): SILVER BEAR OT SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

328 ELIOT LANE
LONG BEACH CA
90814
US

IV. Provider business mailing address

328 ELIOT LN
LONG BEACH CA
90814-3117
US

V. Phone/Fax

Practice location:
  • Phone: 626-600-1045
  • Fax:
Mailing address:
  • Phone: 626-600-1045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: KELLY BOYLE
Title or Position: OCCUPATIONAL THERAPIST
Credential: OTR/L
Phone: 626-600-1045