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General NPI Number Information
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NPI Number | 1215615646
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Entity Type | Organization
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Legal Business Name | LIFEWAY-GAMBURD LLC
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Dates
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Enumeration Date | 07/06/2023
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Last Update Date | 07/06/2023
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Provider Practice Location Address
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Address Line | 12405 MONTAGUE ST
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City | PACOIMA
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State | CA
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Zip | 91331-2122
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Country | US
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Telephone | 310-861-7476
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Fax |
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Provider Business Mailing Address
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Address Line | 1125 MIDDLE ST STE 202D
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City | MIDDLETOWN
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State | CT
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Zip | 06457-1587
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | GENERAL COUNCIL
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Name | BRIAN BURFIELD
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Credential |
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Telephone | 814-594-0185
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XE0001X
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Taxonomy Name | Environmental Modification Occupational Therapist
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License Number |
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License Number State |
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