Provider Demographics
NPI:1265639165
Name:KORNREICH, SUSAN H (OTRL, CHT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:H
Last Name:KORNREICH
Suffix:
Gender:F
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 1:1001 NORTH TUSTIN AVE
Mailing Address - Street 2:WESTERN MEDICAL CENTER
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92701
Mailing Address - Country:US
Mailing Address - Phone:714-953-3605
Mailing Address - Fax:714-953-3442
Practice Address - Street 1:1001 NORTH TUSTIN AVE
Practice Address - Street 2:WESTERN MEDICAL CENTER
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701
Practice Address - Country:US
Practice Address - Phone:714-953-3605
Practice Address - Fax:714-953-3442
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT 2113225X00000X, 225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist