Healthcare Provider Details

I. General information

NPI: 1013834266
Provider Name (Legal Business Name): MICHELLE LAWANTORO MOT, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27227 HERITAGE LAKE DR
MENIFEE CA
92585-2628
US

IV. Provider business mailing address

20392 OPERA LOOP
RIVERSIDE CA
92507-0147
US

V. Phone/Fax

Practice location:
  • Phone: 951-723-1284
  • Fax:
Mailing address:
  • Phone: 909-771-5258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number12213
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: