Healthcare Provider Details

I. General information

NPI: 1134850076
Provider Name (Legal Business Name): CUP OF OT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2022
Last Update Date: 06/21/2022
Certification Date: 06/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4578 JESSICA DR
LOS ANGELES CA
90065-4116
US

IV. Provider business mailing address

350 N GLENDALE AVE STE B
GLENDALE CA
91206-3323
US

V. Phone/Fax

Practice location:
  • Phone: 323-717-6185
  • Fax:
Mailing address:
  • Phone: 323-717-6185
  • 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: MARIANNE MENESES
Title or Position: OCCUPATIONAL THERAPIST
Credential: OTR/L
Phone: 323-717-6185