Provider Demographics
NPI:1912735655
Name:WESTSIDE OCCUPATIONAL THERAPY INC
Entity type:Organization
Organization Name:WESTSIDE OCCUPATIONAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GRETCHEN
Authorized Official - Middle Name:CLARK
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:310-869-2060
Mailing Address - Street 1:11344 BERWICK ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-3414
Mailing Address - Country:US
Mailing Address - Phone:310-869-2060
Mailing Address - Fax:
Practice Address - Street 1:11344 BERWICK ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90049-3414
Practice Address - Country:US
Practice Address - Phone:310-869-2060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-24
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical RehabilitationGroup - Multi-Specialty