Provider Demographics
NPI:1285987503
Name:CHAN, ADLEY (OTD, OTR/L)
Entity type:Individual
Prefix:
First Name:ADLEY
Middle Name:
Last Name:CHAN
Suffix:
Gender:M
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 W 9TH ST
Mailing Address - Street 2:APT. 1014
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90015-4301
Mailing Address - Country:US
Mailing Address - Phone:213-422-6208
Mailing Address - Fax:
Practice Address - Street 1:320 W VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91803-3338
Practice Address - Country:US
Practice Address - Phone:626-289-2268
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-24
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT 11491225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist