Healthcare Provider Details

I. General information

NPI: 1568604775
Provider Name (Legal Business Name): EILEEN DALE MISRAHI OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2009
Last Update Date: 04/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5052 BENEDICT CT
OAK PARK CA
91377-4773
US

IV. Provider business mailing address

5052 BENEDICT CT
OAK PARK CA
91377-4773
US

V. Phone/Fax

Practice location:
  • Phone: 818-292-4345
  • Fax: 818-706-9818
Mailing address:
  • Phone: 818-706-9818
  • Fax: 818-706-9818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number1105
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License Number1105
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code225XL0004X
TaxonomyLow Vision Occupational Therapist
License Number1105
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: