Healthcare Provider Details

I. General information

NPI: 1255294732
Provider Name (Legal Business Name): DANIEL O'ROURKE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2025
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16868 VIA DEL CAMPO CT STE 100
SAN DIEGO CA
92127-1772
US

IV. Provider business mailing address

7 CARNEGIE PLZ
CHERRY HILL NJ
08003-1000
US

V. Phone/Fax

Practice location:
  • Phone: 877-407-3422
  • Fax: 877-407-4329
Mailing address:
  • Phone: 877-407-3422
  • Fax: 877-407-4329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number28066
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: