MEDICARE: VANESSA JOY MESA OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	24576	CA

General Provider Information

NPI Number	:	1154028322
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VANESSA JOY MESA OTR/L

Provider Business Mailing Address
First Line	:	1525 S ADAMS ST
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91205-3606
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5648 GOTHAM ST
Second Line	:
City	:	BELL GARDENS
State	:	CA
Zip	:	90201-5413
Country	:	US
Telephone Number	:	562-927-2641
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/08/2023
Last Update Date	:	02/08/2023

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