Provider Demographics
NPI:1053452680
Name:NEUENDORFF, HAROLD (OTRL, CHT)
Entity Type:Individual
Prefix:
First Name:HAROLD
Middle Name:
Last Name:NEUENDORFF
Suffix:
Gender:M
Credentials:OTRL, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8520
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92375-1720
Mailing Address - Country:US
Mailing Address - Phone:909-557-1600
Mailing Address - Fax:909-557-1740
Practice Address - Street 1:1901 W LUGONIA AVE
Practice Address - Street 2:SUITE 240
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92374-9703
Practice Address - Country:US
Practice Address - Phone:909-557-1600
Practice Address - Fax:909-557-1740
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT3990225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAQ46936Medicare UPIN
CAZZZ02058ZMedicare PIN