Provider Demographics
NPI:1679103154
Name:MAGHEN, ELMIRA (OT)
Entity Type:Individual
Prefix:MS
First Name:ELMIRA
Middle Name:
Last Name:MAGHEN
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 1:19325 SHERMAN WAY
Mailing Address - Street 2:
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-3557
Mailing Address - Country:US
Mailing Address - Phone:818-885-6200
Mailing Address - Fax:818-885-6228
Practice Address - Street 1:19325 SHERMAN WAY
Practice Address - Street 2:
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-3557
Practice Address - Country:US
Practice Address - Phone:818-885-6200
Practice Address - Fax:818-885-6228
Is Sole Proprietor?:No
Enumeration Date:2020-01-23
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT20130225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist