MEDICARE: MARIA RESPICIO 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	3432	CA

General Provider Information

NPI Number	:	1356508774
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA RESPICIO OTR/L

Provider Business Mailing Address
First Line	:	1122 E ELK AVE
Second Line	:	# 105
City	:	GLENDALE
State	:	CA
Zip	:	91205-4603
Country	:	US
Telephone Number	:	818-399-5545
Fax Number	:

Provider Business Practice Location Address
First Line	:	3002 ROWENA AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90039-2005
Country	:	US
Telephone Number	:	323-666-1544
Fax Number	:

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

Provider Enumeration Date	:	05/22/2008
Last Update Date	:	05/22/2008

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