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General NPI Number Information
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NPI Number | 1659002376
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Entity Type | Individual
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Provider Name | SAE PARK OTR/L
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Gender | Female
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Dates
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Enumeration Date | 06/22/2022
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Last Update Date | 06/22/2022
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Provider Practice Location Address
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Address Line | 2560 W OLYMPIC BLVD # 300
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City | LOS ANGELES
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State | CA
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Zip | 90006-2972
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Country | US
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Telephone | 213-388-9995
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Fax |
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Provider Business Mailing Address
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Address Line | 8189 4TH ST UNIT B
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City | BUENA PARK
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State | CA
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Zip | 90621-8406
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Country | US
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Telephone | 714-204-9259
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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 |
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License Number State |
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