Healthcare Provider Details

I. General information

NPI: 1740501683
Provider Name (Legal Business Name): MARIE ARLYNNE LLANOS OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2010
Last Update Date: 12/08/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1526 N EDGEMONT ST
LOS ANGELES CA
90027-5260
US

IV. Provider business mailing address

9 KAITLYN CT
ALISO VIEJO CA
92656-4261
US

V. Phone/Fax

Practice location:
  • Phone: 323-783-1346
  • Fax:
Mailing address:
  • Phone: 323-594-2240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number11221
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: