Healthcare Provider Details

I. General information

NPI: 1659495927
Provider Name (Legal Business Name): CHRISTOPHER SORRELLS OTR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 05/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1260 15TH ST SUITE 900
SANTA MONICA CA
90404-1135
US

IV. Provider business mailing address

165 YORBA ST
TUSTIN CA
92780-2924
US

V. Phone/Fax

Practice location:
  • Phone: 310-451-2292
  • Fax: 310-451-2554
Mailing address:
  • Phone: 714-731-2441
  • Fax: 714-731-1594

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5715
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: