MEDICARE: MR. CONOR J MCCULLOUGH O.T.

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	225XH1200X	Hand Occupational Therapist	OT4136	CA

General Provider Information

NPI Number	:	1841313459
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CONOR J MCCULLOUGH O.T.

Provider Business Mailing Address
First Line	:	22020 COHASSET ST
Second Line	:
City	:	CANOGA PARK
State	:	CA
Zip	:	91303-1122
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5601 DESOTO AVE
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91365
Country	:	US
Telephone Number	:	818-719-2930
Fax Number	:

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

Provider Enumeration Date	:	04/09/2007
Last Update Date	:	12/06/2021

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