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General NPI Number Information
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NPI Number | 1063924355
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Entity Type | Individual
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Provider Name | LIANNA RAQUEL GOLD MS, OTR/L
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Gender | Female
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Dates
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Enumeration Date | 10/26/2017
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Last Update Date | 10/26/2017
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Provider Practice Location Address
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Address Line | 18401 BURBANK BLVD STE 201
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City | TARZANA
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State | CA
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Zip | 91356-6601
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Country | US
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Telephone | 818-275-7537
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Fax |
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Provider Business Mailing Address
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Address Line | 24718 VIA MADERA
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City | CALABASAS
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State | CA
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Zip | 91302-3021
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Country | US
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Telephone | 805-551-6199
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Fax | 805-551-6199
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT11415
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License Number State | CA
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