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General NPI Number Information
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NPI Number | 1841582020
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Entity Type | Individual
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Provider Name | WAYNE BRIAN CENTRA MOTR/L
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Gender | Male
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Dates
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Enumeration Date | 05/06/2011
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Last Update Date | 04/20/2017
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Provider Practice Location Address
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Address Line | 3002 DOW AVE 114
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City | TUSTIN
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State | CA
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Zip | 92780-7233
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Country | US
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Telephone | 714-731-4668
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Fax | 714-464-4668
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Provider Business Mailing Address
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Address Line | 3002 DOW AVE 114
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City | TUSTIN
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State | CA
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Zip | 92780-7233
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Country | US
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Telephone | 714-731-4668
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Fax | 714-464-4668
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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 | OT-5499
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License Number State | CA
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