Provider Demographics
NPI:1043691983
Name:KOURA, TARUNA (OTR/L)
Entity type:Individual
Prefix:
First Name:TARUNA
Middle Name:
Last Name:KOURA
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 1:22365 GOLDEN CANYON CIR
Mailing Address - Street 2:
Mailing Address - City:CHATSWORTH
Mailing Address - State:CA
Mailing Address - Zip Code:91311-1261
Mailing Address - Country:US
Mailing Address - Phone:757-218-0491
Mailing Address - Fax:
Practice Address - Street 1:22365 GOLDEN CANYON CIR
Practice Address - Street 2:
Practice Address - City:CHATSWORTH
Practice Address - State:CA
Practice Address - Zip Code:91311-1261
Practice Address - Country:US
Practice Address - Phone:757-218-0491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-16
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA15419OtherLICENSED OCCUPATIONAL THERAPIST
343235OtherOCCUPATIONAL THERAPIST REGISTERED