Healthcare Provider Details

I. General information

NPI: 1972059285
Provider Name (Legal Business Name): LAUREN WITMAN OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2016
Last Update Date: 12/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 S PLACENTIA AVE STE 100
PLACENTIA CA
92870-6832
US

IV. Provider business mailing address

130 E CHAPMAN AVE APT 336
FULLERTON CA
92832-1993
US

V. Phone/Fax

Practice location:
  • Phone: 714-646-8318
  • Fax: 714-646-8320
Mailing address:
  • Phone: 805-208-5874
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number17915
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: