Healthcare Provider Details

I. General information

NPI: 1841043395
Provider Name (Legal Business Name): MAIPA VANG TOLONEN OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2024
Last Update Date: 04/05/2024
Certification Date: 04/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

714 W OLYMPIC BLVD STE 614
LOS ANGELES CA
90015-1485
US

IV. Provider business mailing address

714 W OLYMPIC BLVD STE 614
LOS ANGELES CA
90015-1485
US

V. Phone/Fax

Practice location:
  • Phone: 323-419-3869
  • Fax:
Mailing address:
  • Phone: 323-419-3869
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number15399
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225XE1200X
TaxonomyErgonomics Occupational Therapist
License Number15399
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code225XM0800X
TaxonomyMental Health Occupational Therapist
License Number15399
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code225XE0001X
TaxonomyEnvironmental Modification Occupational Therapist
License Number15399
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: