Provider Demographics
NPI:1972807154
Name:BOURELL, LINDA MARIE (OTR-L)
Entity type:Individual
Prefix:MS
First Name:LINDA
Middle Name:MARIE
Last Name:BOURELL
Suffix:
Gender:F
Credentials:OTR-L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 STADIUM WAY
Mailing Address - Street 2:N/A
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90026-2606
Mailing Address - Country:US
Mailing Address - Phone:213-250-4200
Mailing Address - Fax:213-202-6805
Practice Address - Street 1:1700 ARMACOST AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-3804
Practice Address - Country:US
Practice Address - Phone:310-826-7935
Practice Address - Fax:310-826-7935
Is Sole Proprietor?:No
Enumeration Date:2011-01-03
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9901225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist