Individual
MISS LICHELLE AYESHA FERNANDO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
4650 W SUNSET BLVD, LOS ANGELES, CA 90027-6062
(323) 669-2118
Mailing address
4335 WILLIS AVE, # 103, SHERMAN OAKS, CA 91403
(773) 895-4575
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
9200
CA
Other
Enumeration date
03/14/2007
Last updated
10/26/2007
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