Healthcare Provider Details

I. General information

NPI: 1902184401
Provider Name (Legal Business Name): LORI A OCKER PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2011
Last Update Date: 08/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1313 W 8TH ST STE 100
LOS ANGELES CA
90017-4420
US

IV. Provider business mailing address

8770 SHOREHAM DR APT 7
WEST HOLLYWOOD CA
90069-2214
US

V. Phone/Fax

Practice location:
  • Phone: 213-401-1970
  • Fax:
Mailing address:
  • Phone: 717-475-3189
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberAT 9080
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: