Healthcare Provider Details

I. General information

NPI: 1376778928
Provider Name (Legal Business Name): IRENE VILLAR PHD., OTR/L, SWC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2009
Last Update Date: 05/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 E FOOTHILL BLVD STE 100
ARCADIA CA
91006-2314
US

IV. Provider business mailing address

50 E FOOTHILL BLVD STE 100
ARCADIA CA
91006-2314
US

V. Phone/Fax

Practice location:
  • Phone: 626-445-2400
  • Fax: 626-445-2419
Mailing address:
  • Phone: 626-445-2400
  • Fax: 626-445-2419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT1509
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225XF0002X
TaxonomyFeeding, Eating & Swallowing Occupational Therapist
License NumberOT1509
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: