MEDICARE: ALLISON JEAN L'HOTTA OTD

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
1	225XP0200X	Pediatric Occupational Therapist	13374	CA

General Provider Information

NPI Number	:	1497187934
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALLISON JEAN L'HOTTA OTD

Provider Business Mailing Address
First Line	:	460 1/2 N GENESEE AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90036-2253
Country	:	US
Telephone Number	:	630-484-3143
Fax Number	:

Provider Business Practice Location Address
First Line	:	460 1/2 N GENESEE AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90036-2253
Country	:	US
Telephone Number	:	630-484-3143
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/07/2013
Last Update Date	:	08/07/2013

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