Provider Demographics
NPI:1861279101
Name:BOETEL, WHITNEY M (MS, OT, C/NDT)
Entity type:Individual
Prefix:
First Name:WHITNEY
Middle Name:M
Last Name:BOETEL
Suffix:
Gender:F
Credentials:MS, OT, C/NDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7739 E PORTOFINO AVE
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92808-1569
Mailing Address - Country:US
Mailing Address - Phone:714-227-7783
Mailing Address - Fax:
Practice Address - Street 1:7739 E PORTOFINO AVE
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92808-1569
Practice Address - Country:US
Practice Address - Phone:714-227-7783
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18482225XN1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitation