Healthcare Provider Details

I. General information

NPI: 1851038103
Provider Name (Legal Business Name): EMILY ROURKE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2022
Last Update Date: 03/04/2025
Certification Date: 03/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1721 GRIFFIN AVE
LOS ANGELES CA
90031-3312
US

IV. Provider business mailing address

11460 W WASHINGTON BLVD
LOS ANGELES CA
90066-6030
US

V. Phone/Fax

Practice location:
  • Phone: 323-221-4134
  • Fax:
Mailing address:
  • Phone: 310-337-7115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number24285
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: