Provider Demographics
NPI:1265778914
Name:TERREBONNE, NANCY M (OTR/L)
Entity type:Individual
Prefix:MS
First Name:NANCY
Middle Name:M
Last Name:TERREBONNE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4924 VALJEAN AVE
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-1336
Mailing Address - Country:US
Mailing Address - Phone:818-788-2511
Mailing Address - Fax:
Practice Address - Street 1:6345 BALBOA BLVD
Practice Address - Street 2:SUITE 120
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-1519
Practice Address - Country:US
Practice Address - Phone:818-881-7600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-28
Last Update Date:2012-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT 309225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist