Provider Demographics
NPI:1326355009
Name:FORMAN, YAEL L (OTR/L)
Entity Type:Individual
Prefix:
First Name:YAEL
Middle Name:L
Last Name:FORMAN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5206 PESTO WAY
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91377-4840
Mailing Address - Country:US
Mailing Address - Phone:310-614-3402
Mailing Address - Fax:
Practice Address - Street 1:5206 PESTO WAY
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:CA
Practice Address - Zip Code:91377-4840
Practice Address - Country:US
Practice Address - Phone:310-614-3402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-01
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACBOT 6660225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics