MEDICARE: MISS EILEEN DALE MISRAHI OTR/L

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	225X00000X	Occupational Therapist	1105	CA
2	225XG0600X	Gerontology Occupational Therapist	1105	CA
3	225XL0004X	Low Vision Occupational Therapist	1105	CA

General Provider Information

NPI Number	:	1568604775
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS EILEEN DALE MISRAHI OTR/L

Provider Business Mailing Address
First Line	:	5052 BENEDICT CT
Second Line	:
City	:	OAK PARK
State	:	CA
Zip	:	91377-4773
Country	:	US
Telephone Number	:	818-706-9818
Fax Number	:	818-706-9818

Provider Business Practice Location Address
First Line	:	5052 BENEDICT CT
Second Line	:
City	:	OAK PARK
State	:	CA
Zip	:	91377-4773
Country	:	US
Telephone Number	:	818-292-4345
Fax Number	:	818-706-9818

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

Provider Enumeration Date	:	04/02/2009
Last Update Date	:	04/02/2009

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