Individual
YAEL L FORMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
5206 PESTO WAY, OAK PARK, CA 91377-4840
(310) 614-3402
Mailing address
5206 PESTO WAY, OAK PARK, CA 91377-4840
(310) 614-3402
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
CBOT 6660
CA
Other
Enumeration date
09/01/2010
Last updated
09/01/2010
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