Provider Demographics
NPI:1598475378
Name:SALEH, KENZIE HOSSAM (OTD, OTR/L)
Entity Type:Individual
Prefix:
First Name:KENZIE
Middle Name:HOSSAM
Last Name:SALEH
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 HOLLYHOCK LN
Mailing Address - Street 2:
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-2952
Mailing Address - Country:US
Mailing Address - Phone:949-294-4454
Mailing Address - Fax:
Practice Address - Street 1:15375 BARRANCA PKWY STE A103
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-2203
Practice Address - Country:US
Practice Address - Phone:949-590-9350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-01
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24175225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist