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General NPI Number Information
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NPI Number | 1275987398
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Entity Type | Individual
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Provider Name | KELLY TRICIA MEIJUN MAR OTR/L
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Gender | Female
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Dates
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Enumeration Date | 04/14/2016
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Last Update Date | 04/14/2016
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Provider Practice Location Address
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Address Line | 12411 SLAUSON AVE UNIT H
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City | WHITTIER
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State | CA
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Zip | 90606-2835
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Country | US
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Telephone | 562-693-5449
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Fax | 562-693-5469
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Provider Business Mailing Address
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Address Line | 1615 LAS FLORES AVE
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City | SAN MARINO
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State | CA
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Zip | 91108-1615
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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 | 16071
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License Number State | CA
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