Basic Information
Provider Information
NPI: 1255854196
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SPITZER
FirstName: KARLEY
MiddleName: CHRISTINA
NamePrefix:  
NameSuffix:  
Credential: OTR
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: BURWELL
OtherFirstName: KARLEY
OtherMiddleName: CHRISTINA
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType: 1
Mailing Information
Address1: 424 E FREELAND ST APT 1
Address2:  
City: LONG BEACH
State: CA
PostalCode: 908072138
CountryCode: US
TelephoneNumber: 9094997123
FaxNumber:  
Practice Location
Address1: 12411 SLAUSON AVE
Address2:  
City: WHITTIER
State: CA
PostalCode: 906062835
CountryCode: US
TelephoneNumber: 5626935449
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/23/2017
LastUpdateDate: 07/23/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225X00000X  Y Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist 

No ID Information.


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