Provider Demographics
NPI:1467840165
Name:LINDERMAN, KORY (OTR/L)
Entity Type:Individual
Prefix:
First Name:KORY
Middle Name:
Last Name:LINDERMAN
Suffix:
Gender:M
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 1:109 N SYCAMORE AVE APT 503
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90036-2954
Mailing Address - Country:US
Mailing Address - Phone:323-253-7844
Mailing Address - Fax:
Practice Address - Street 1:109 N SYCAMORE AVE APT 503
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90036-2954
Practice Address - Country:US
Practice Address - Phone:323-253-7844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-03
Last Update Date:2015-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6311225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist