Provider Demographics
NPI:1295106771
Name:LEVINE-DICKMAN, AIMEE (OTR/L)
Entity type:Individual
Prefix:
First Name:AIMEE
Middle Name:
Last Name:LEVINE-DICKMAN
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 1:1122 6TH ST APT 202
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-5168
Mailing Address - Country:US
Mailing Address - Phone:310-745-2621
Mailing Address - Fax:
Practice Address - Street 1:10780 SANTA MONICA BOULEVARD, STE. 105
Practice Address - Street 2:THE CAMDEN CENTER
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025
Practice Address - Country:US
Practice Address - Phone:310-745-2621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-09
Last Update Date:2015-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9057225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist