Provider Demographics
NPI:1831297340
Name:USC OCCUPATIONAL THERAPY FACULTY PRACTICE, INC.
Entity Type:Organization
Organization Name:USC OCCUPATIONAL THERAPY FACULTY PRACTICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:KATHERINE
Authorized Official - Last Name:SALLES
Authorized Official - Suffix:
Authorized Official - Credentials:OTD
Authorized Official - Phone:323-442-3340
Mailing Address - Street 1:2250 ALCAZAR STREET
Mailing Address - Street 2:CSC-133
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90089-9068
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2250 ALCAZAR STREET
Practice Address - Street 2:CSC-133
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90089-9068
Practice Address - Country:US
Practice Address - Phone:323-442-3340
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty