Healthcare Provider Details

I. General information

NPI: 1922712264
Provider Name (Legal Business Name): COREY STRAILY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2023
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 NORMAL ST
SAN DIEGO CA
92103-2653
US

IV. Provider business mailing address

3513 STEEL CANYON RD
SPRING VALLEY CA
91978-2340
US

V. Phone/Fax

Practice location:
  • Phone: 619-725-5501
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number4851
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: