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NPI Code Detail

MEDICARE: MS. JUSTINE ANN DAVID MAOT OTR/L

MEDICARE: MS. JUSTINE ANN DAVID MAOT 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
1225XP0200XPediatric Occupational Therapist16833CA

General Provider Information

NPI Number : 1649648130
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. JUSTINE ANN DAVID MAOT OTR/L
Provider Business Mailing Address
First Line : 120 S VIGNES ST
Second Line : APT 401
City : LOS ANGELES
State : CA
Zip : 90012-4324
Country : US
Telephone Number : 562-310-1840
Fax Number :
Provider Business Practice Location Address
First Line : 3031 BEVERLY BLVD
Second Line : SUITE B
City : LOS ANGELES
State : CA
Zip : 90057-1013
Country : US
Telephone Number : 323-644-9380
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/14/2015
Last Update Date : 11/03/2016

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