Individual
ELLEN PARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
3148 W 11TH ST, LOS ANGELES, CA 90006-2322
(213) 200-2591
Mailing address
3148 W 11TH ST, LOS ANGELES, CA 90006-2322
(213) 200-2591
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
439575
CA
Other
Enumeration date
08/20/2020
Last updated
08/20/2020
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