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General NPI Number Information
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NPI Number | 1609441252
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Entity Type | Individual
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Provider Name | SUSAN AVILA OTR/L
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Gender | Female
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Dates
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Enumeration Date | 05/26/2021
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Last Update Date | 05/26/2021
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Provider Practice Location Address
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Address Line | 6425 MILES AVE
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City | HUNTINGTON PARK
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State | CA
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Zip | 90255-4315
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Country | US
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Telephone | 310-567-3057
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Fax |
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Provider Business Mailing Address
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Address Line | 1520 W 212TH ST
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City | TORRANCE
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State | CA
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Zip | 90501-2901
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Country | US
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Telephone | 310-567-3057
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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 | 8250
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License Number State | CA
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