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General NPI Number Information
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NPI Number | 1205773751
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Entity Type | Individual
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Provider Name | DESIRAE ALMA NADEEN VILLARREAL
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Gender | Female
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Dates
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Enumeration Date | 05/01/2026
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Last Update Date | 05/01/2026
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Provider Practice Location Address
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Address Line | 3529 RIVERS EDGE DR
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City | PERRYSBURG
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State | OH
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Zip | 43551-1672
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Country | US
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Telephone | 419-874-2428
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Fax |
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Provider Business Mailing Address
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Address Line | 11100 WALLACE RD
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City | CURTICE
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State | OH
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Zip | 43412-9466
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Country | US
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Telephone | 419-607-0282
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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 | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | OTA008784
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License Number State | OH
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