Healthcare Provider Details

I. General information

NPI: 1205214392
Provider Name (Legal Business Name): HEATHER GENE VAN BUREN OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2015
Last Update Date: 12/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2189 EASTMAN AVE.
VENTURA CA
93003
US

IV. Provider business mailing address

2189 EASTMAN AVE
VENTURA CA
93003-5792
US

V. Phone/Fax

Practice location:
  • Phone: 805-639-2600
  • Fax:
Mailing address:
  • Phone: 805-639-2600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License NumberOT16740
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: