Provider Demographics
NPI:1609900257
Name:MAK, EDITH M (OTR)
Entity Type:Individual
Prefix:MS
First Name:EDITH
Middle Name:M
Last Name:MAK
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:PO BOX 64855
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-0855
Mailing Address - Country:US
Mailing Address - Phone:310-790-4292
Mailing Address - Fax:310-470-5971
Practice Address - Street 1:2355 WESTWOOD BLVD
Practice Address - Street 2:#703
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-2109
Practice Address - Country:US
Practice Address - Phone:310-790-4292
Practice Address - Fax:310-470-5971
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA855225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics