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General NPI Number Information
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NPI Number | 1750025755
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Entity Type | Individual
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Provider Name | LILYANN KATHERINE HALBO OTR/L
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Gender | Female
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Dates
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Enumeration Date | 04/25/2022
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Last Update Date | 10/21/2024
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Provider Practice Location Address
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Address Line | 11838 BERNARDO PLAZA CT STE 110
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City | SAN DIEGO
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State | CA
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Zip | 92128-2414
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Country | US
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Telephone | 858-673-5437
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Fax |
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Provider Business Mailing Address
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Address Line | 12427 HEATHERTON CT APT 245
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City | SAN DIEGO
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State | CA
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Zip | 92128-5178
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Country | US
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Telephone |
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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 | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | 25601
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License Number State | CA
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