Provider Demographics
NPI:1619368164
Name:SEHREMELIS, TINA ANN (OTR/L)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:ANN
Last Name:SEHREMELIS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:TINA
Other - Middle Name:ANN
Other - Last Name:SEHREMELIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTD, OTR/L
Mailing Address - Street 1:11376 BASKERVILLE RD
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-2928
Mailing Address - Country:US
Mailing Address - Phone:562-881-6895
Mailing Address - Fax:
Practice Address - Street 1:1310 W STEWART DR STE 203
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3837
Practice Address - Country:US
Practice Address - Phone:714-771-8222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-05
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
CAOT16843225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator