MEDICARE: SHEILA PIA DEQUINA OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	012592-1	NY
2	225XP0019X	Physical Rehabilitation Occupational Therapist	10147	CA

General Provider Information

NPI Number	:	1053533927
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHEILA PIA DEQUINA OTR/L

Provider Business Mailing Address
First Line	:	2140 W OLYMPIC BLVD
Second Line	:	302
City	:	LOS ANGELES
State	:	CA
Zip	:	90006-2207
Country	:	US
Telephone Number	:	213-487-7792
Fax Number	:

Provider Business Practice Location Address
First Line	:	2140 W OLYMPIC BLVD
Second Line	:	302
City	:	LOS ANGELES
State	:	CA
Zip	:	90006-2207
Country	:	US
Telephone Number	:	213-487-7792
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/02/2007
Last Update Date	:	04/20/2020

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