Provider Demographics
NPI:1265146997
Name:SURRETT, JOSEFINA (OT)
Entity type:Individual
Prefix:
First Name:JOSEFINA
Middle Name:
Last Name:SURRETT
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 1:1738 N WARBLER PL
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92867-8416
Mailing Address - Country:US
Mailing Address - Phone:562-413-1429
Mailing Address - Fax:
Practice Address - Street 1:1738 N WARBLER PL
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92867-8416
Practice Address - Country:US
Practice Address - Phone:562-413-1429
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-09
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8592225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist