Provider Demographics
NPI:1629680269
Name:CHEN, YANNIE LU (OTR)
Entity Type:Individual
Prefix:
First Name:YANNIE
Middle Name:LU
Last Name:CHEN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:YANLU
Other - Middle Name:
Other - Last Name:CHEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR
Mailing Address - Street 1:41769 ENTERPRISE CIR N STE 104&105
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92590-5626
Mailing Address - Country:US
Mailing Address - Phone:951-303-8255
Mailing Address - Fax:951-719-3429
Practice Address - Street 1:41769 ENTERPRISE CIR N STE 104&105
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-5626
Practice Address - Country:US
Practice Address - Phone:951-303-8255
Practice Address - Fax:951-719-3429
Is Sole Proprietor?:No
Enumeration Date:2020-08-17
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21087225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist