Provider Demographics
NPI:1518210467
Name:SILCHUK, IRINA (OTR/L)
Entity Type:Individual
Prefix:MISS
First Name:IRINA
Middle Name:
Last Name:SILCHUK
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 1:200 NEWPORT CENTER DR
Mailing Address - Street 2:#213
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-7501
Mailing Address - Country:US
Mailing Address - Phone:949-644-1322
Mailing Address - Fax:949-644-0316
Practice Address - Street 1:12555 LAKEWOOD BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90242-2771
Practice Address - Country:US
Practice Address - Phone:562-923-4704
Practice Address - Fax:562-923-6709
Is Sole Proprietor?:No
Enumeration Date:2012-10-16
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12082225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGS981YMedicare PIN