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General NPI Number Information
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NPI Number | 1255288304
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Entity Type | Individual
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Provider Name | KORINNE NICOLE PETRIS OTR/L
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Gender | Female
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Dates
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Enumeration Date | 03/16/2026
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Last Update Date | 03/16/2026
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Provider Practice Location Address
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Address Line | 5450 VESPER AVE
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City | SHERMAN OAKS
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State | CA
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Zip | 91411-4221
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Country | US
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Telephone | 747-277-3990
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Fax |
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Provider Business Mailing Address
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Address Line | 82 DOW JONES ST UNIT 2
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City | HENDERSON
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State | NV
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Zip | 89074-8982
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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 |
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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 | 17821
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License Number State | CA
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