Healthcare Provider Details

I. General information

NPI: 1801211313
Provider Name (Legal Business Name): MERI ESCOBAR OTR/L,MLD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2014
Last Update Date: 02/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 KENTWORTH
IRVINE CA
92602-0110
US

IV. Provider business mailing address

39 KENTWORTH
IRVINE CA
92602-0110
US

V. Phone/Fax

Practice location:
  • Phone: 714-812-0064
  • Fax: 714-505-0011
Mailing address:
  • Phone: 714-812-0064
  • Fax: 714-505-0011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License NumberOT887
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License NumberOT887
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: