MEDICARE: TAMARA MCCULLEY 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	16393	CA

General Provider Information

NPI Number	:	1689025637
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMARA MCCULLEY OTR/L

Provider Business Mailing Address
First Line	:	3111 N TUSTIN ST STE 180
Second Line	:
City	:	ORANGE
State	:	CA
Zip	:	92865-1752
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3111 N TUSTIN ST STE 180
Second Line	:
City	:	ORANGE
State	:	CA
Zip	:	92865-1752
Country	:	US
Telephone Number	:	714-282-7701
Fax Number	:

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

Provider Enumeration Date	:	06/30/2016
Last Update Date	:	08/30/2022

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