Provider Demographics
NPI:1679900906
Name:LAFAELE, BERNADETTE (OT)
Entity type:Individual
Prefix:
First Name:BERNADETTE
Middle Name:
Last Name:LAFAELE
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 1:11037 WARNER AVE
Mailing Address - Street 2:SUITE 339
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-4007
Mailing Address - Country:US
Mailing Address - Phone:503-298-5359
Mailing Address - Fax:949-253-4627
Practice Address - Street 1:11037 WARNER AVE
Practice Address - Street 2:SUITE 339
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-4007
Practice Address - Country:US
Practice Address - Phone:503-298-5359
Practice Address - Fax:949-253-4627
Is Sole Proprietor?:No
Enumeration Date:2013-10-01
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13573225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist