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General NPI Number Information
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NPI Number | 1760908149
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Entity Type | Individual
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Provider Name | ROBERTO ESTRELLADO OTR/L, DOR
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Gender | Male
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Dates
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Enumeration Date | 08/17/2017
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Last Update Date | 08/17/2017
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Provider Practice Location Address
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Address Line | 212 FAIRVIEW ST
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City | CENTERBURG
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State | OH
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Zip | 43011-8314
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Country | US
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Telephone | 740-625-5774
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Fax |
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Provider Business Mailing Address
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Address Line | 212 FAIRVIEW ST
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City | CENTERBURG
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State | OH
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Zip | 43011-8314
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT-6110
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License Number State | OH
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