Provider Demographics
NPI:1629596622
Name:JOHARCHI, AVERY L (OT)
Entity Type:Individual
Prefix:
First Name:AVERY
Middle Name:L
Last Name:JOHARCHI
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7921 PROFESSIONAL CIR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-1901
Mailing Address - Country:US
Mailing Address - Phone:714-847-8751
Mailing Address - Fax:714-847-8751
Practice Address - Street 1:7921 PROFESSIONAL CIR
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-1901
Practice Address - Country:US
Practice Address - Phone:714-847-8751
Practice Address - Fax:714-847-8751
Is Sole Proprietor?:No
Enumeration Date:2017-08-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT16381225X00000X
CA293906225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA357983OtherTHE NATIONAL BOARD FOR CERTIFICATION IN OCCUPATIONAL THERAPY, INC.
CAOT16381OtherCA BOARD OF OCCUPATIONAL THERAPY