Healthcare Provider Details

I. General information

NPI: 1366732786
Provider Name (Legal Business Name): PHAEDRA LYNN GIANNINI OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2011
Last Update Date: 08/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8135 PAINTER AVE STE 200
WHITTIER CA
90602-3168
US

IV. Provider business mailing address

2700 CAHUENGA BLVD E APT 2315
LOS ANGELES CA
90068-2146
US

V. Phone/Fax

Practice location:
  • Phone: 562-698-6600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number13612
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: