Healthcare Provider Details

I. General information

NPI: 1376892646
Provider Name (Legal Business Name): MICHELLE L. RADMORE OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2012
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25631 PETER A HARTMAN WAY
MISSION VIEJO CA
92691-3142
US

IV. Provider business mailing address

22632 LEAFLOCK ST
LAKE FOREST CA
92630-3619
US

V. Phone/Fax

Practice location:
  • Phone: 949-586-1234
  • Fax:
Mailing address:
  • Phone: 949-463-4599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number6790
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: