Provider Demographics
NPI:1275991010
Name:NADER, MICHAEL JOSEPH (OT)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:JOSEPH
Last Name:NADER
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16030 VENTURA BLVD
Mailing Address - Street 2:#100
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2754
Mailing Address - Country:US
Mailing Address - Phone:818-981-3688
Mailing Address - Fax:818-981-3588
Practice Address - Street 1:16030 VENTURA BLVD
Practice Address - Street 2:#100
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2754
Practice Address - Country:US
Practice Address - Phone:818-981-3688
Practice Address - Fax:818-981-3588
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225400000X, 390200000X
CAOT17557225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty