Provider Demographics
NPI:1942556600
Name:SOMMERHALDER, PAULA (OT)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:
Last Name:SOMMERHALDER
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 1:200 NEWPORT CENTER DR
Mailing Address - Street 2:#213
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-7501
Mailing Address - Country:US
Mailing Address - Phone:310-854-0529
Mailing Address - Fax:310-854-0768
Practice Address - Street 1:8907 WILSHIRE BLVD
Practice Address - Street 2:#248
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-1937
Practice Address - Country:US
Practice Address - Phone:310-854-0529
Practice Address - Fax:310-854-0768
Is Sole Proprietor?:No
Enumeration Date:2012-07-31
Last Update Date:2012-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT 12779225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGT001ZMedicare PIN