=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174402663
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SAVANNAH ALEXIA LONGORIA OTD, OTR/L
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/28/2025
-----------------------------------------------------
Last Update Date | 09/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1900 GARDEN RD STE 200
-----------------------------------------------------
City | MONTEREY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93940-5334
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 831-250-6770
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12 RIKER CIR
-----------------------------------------------------
City | SALINAS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93901-2114
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 831-595-2417
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 28136
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------