Provider Demographics
NPI:1912229493
Name:SERRANO, JOEY CHAN (OT)
Entity Type:Individual
Prefix:MR
First Name:JOEY
Middle Name:CHAN
Last Name:SERRANO
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 S ORANGE AVE
Mailing Address - Street 2:
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-4953
Mailing Address - Country:US
Mailing Address - Phone:336-453-8898
Mailing Address - Fax:
Practice Address - Street 1:141 S ORANGE AVE
Practice Address - Street 2:
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-4953
Practice Address - Country:US
Practice Address - Phone:336-453-8898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-24
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7409225X00000X
CA11129225X00000X
FL14049225X00000X
ZZ0000394225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist