Healthcare Provider Details

I. General information

NPI: 1437357167
Provider Name (Legal Business Name): ALKA A BAGWE OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 W CHAPMAN AVE
ORANGE CA
92868-1505
US

IV. Provider business mailing address

20525 WARDHAM AVE
LAKEWOOD CA
90715-1823
US

V. Phone/Fax

Practice location:
  • Phone: 714-748-6166
  • Fax:
Mailing address:
  • Phone: 562-276-8903
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License NumberOT3623
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: