Healthcare Provider Details

I. General information

NPI: 1154802536
Provider Name (Legal Business Name): MELISA ESCAMILLA OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2018
Last Update Date: 08/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7840 MISSION CENTER CT
SAN DIEGO CA
92108-1319
US

IV. Provider business mailing address

4856 DEL MONTE AVE APT 3
SAN DIEGO CA
92107-3254
US

V. Phone/Fax

Practice location:
  • Phone: 619-692-0622
  • Fax:
Mailing address:
  • Phone: 951-719-9058
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number18900
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: