Provider Demographics
NPI:1437715497
Name:WARNER, GREGORY (OT)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:
Last Name:WARNER
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 1:22891 VIA SANTIAGO
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-2130
Mailing Address - Country:US
Mailing Address - Phone:949-306-9443
Mailing Address - Fax:
Practice Address - Street 1:32170 NIGUEL RD
Practice Address - Street 2:
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-4264
Practice Address - Country:US
Practice Address - Phone:949-669-2129
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-15
Last Update Date:2023-03-08
Deactivation Date:2023-01-24
Deactivation Code:
Reactivation Date:2023-02-11
Provider Licenses
StateLicense IDTaxonomies
106S00000X
CA24602225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician