Healthcare Provider Details

I. General information

NPI: 1902312366
Provider Name (Legal Business Name): EMILY MIRZAEE OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2017
Last Update Date: 12/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1932 14TH ST # CA
SANTA MONICA CA
90404-4605
US

IV. Provider business mailing address

929 N HARWOOD ST
ORANGE CA
92867-5742
US

V. Phone/Fax

Practice location:
  • Phone: 310-344-2276
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: