=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649833054
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NEIKA ELAINE MARYN OTR/L
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/22/2019
-----------------------------------------------------
Last Update Date | 04/22/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 660 CAMINO MAGNIFICO
-----------------------------------------------------
City | SAN MARCOS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92069-7323
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-290-2199
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6351 CLEO ST
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92115-1522
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-815-3445
-----------------------------------------------------
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 | 16501
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------