Healthcare Provider Details

I. General information

NPI: 1245164847
Provider Name (Legal Business Name): MARILYN CHIU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

351 S HUDSON AVE
PASADENA CA
91101-3599
US

IV. Provider business mailing address

2820 LINCOLN AVE
ALTADENA CA
91001-4549
US

V. Phone/Fax

Practice location:
  • Phone: 626-396-3600
  • Fax:
Mailing address:
  • Phone: 949-294-0423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number12965
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: