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NPI Code Detail

MEDICARE: WINRIGHT DOMINIC TAN OT

MEDICARE: WINRIGHT DOMINIC TAN OT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational TherapistOT9459CA

General Provider Information

NPI Number : 1407988959
Entity Type Code : Individual
Provider Name (Legal Business Name) : WINRIGHT DOMINIC TAN OT
Provider Business Mailing Address
First Line : 8167 W 3RD ST.
Second Line :
City : LOS ANGELES
State : CA
Zip : 90048
Country : US
Telephone Number : 323-655-2023
Fax Number :
Provider Business Practice Location Address
First Line : 8167 W 3RD ST
Second Line :
City : LOS ANGELES
State : CA
Zip : 90048-4314
Country : US
Telephone Number : 323-655-2023
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/11/2007
Last Update Date : 02/10/2015

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Directions to “ WINRIGHT DOMINIC TAN OT” Practice Location

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