Provider Demographics
NPI:1982102752
Name:AMZALLAG, YAEL (OTR/L)
Entity Type:Individual
Prefix:
First Name:YAEL
Middle Name:
Last Name:AMZALLAG
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 1:15009 MOORPARK ST APT 204
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-5405
Mailing Address - Country:US
Mailing Address - Phone:818-923-0918
Mailing Address - Fax:
Practice Address - Street 1:5359 BALBOA BLVD STE A
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-2834
Practice Address - Country:US
Practice Address - Phone:818-849-5396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-26
Last Update Date:2018-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist