Provider Demographics
NPI:1619236411
Name:MORI, ANNIE BALTAZAR (OTD, OTR/L)
Entity Type:Individual
Prefix:DR
First Name:ANNIE
Middle Name:BALTAZAR
Last Name:MORI
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 1:5526 ARVADA ST
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-1204
Mailing Address - Country:US
Mailing Address - Phone:310-753-4152
Mailing Address - Fax:
Practice Address - Street 1:5526 ARVADA ST
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-1204
Practice Address - Country:US
Practice Address - Phone:310-753-4152
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-14
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT 1410225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics