Provider Demographics
NPI:1568604775
Name:MISRAHI, EILEEN DALE (OTR/L)
Entity Type:Individual
Prefix:MISS
First Name:EILEEN
Middle Name:DALE
Last Name:MISRAHI
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 1:5052 BENEDICT CT
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91377-4773
Mailing Address - Country:US
Mailing Address - Phone:818-706-9818
Mailing Address - Fax:818-706-9818
Practice Address - Street 1:5052 BENEDICT CT
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:CA
Practice Address - Zip Code:91377-4773
Practice Address - Country:US
Practice Address - Phone:818-292-4345
Practice Address - Fax:818-706-9818
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-02
Last Update Date:2009-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1105225X00000X, 225XG0600X, 225XL0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XL0004XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistLow Vision