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General NPI Number Information
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NPI Number | 1063111813
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Entity Type | Individual
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Provider Name | EDWARD JOSEPH SEVILLA OTR/L
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Gender | Male
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Dates
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Enumeration Date | 03/01/2023
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Last Update Date | 03/01/2023
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Provider Practice Location Address
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Address Line | 1610 ARDEN WAY STE 195
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City | SACRAMENTO
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State | CA
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Zip | 95815-4035
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Country | US
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Telephone | 137-991-6649
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Fax |
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Provider Business Mailing Address
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Address Line | 2575 BEACHWOOD DR
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City | MERCED
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State | CA
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Zip | 95348-3608
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Country | US
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Telephone | 209-761-9890
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 24739
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License Number State | CA
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