Provider Demographics
NPI:1033542741
Name:PESHCHEROVA, DARIA (OT)
Entity Type:Individual
Prefix:
First Name:DARIA
Middle Name:
Last Name:PESHCHEROVA
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:DASHA
Other - Middle Name:
Other - Last Name:PESHCHEROVA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OT
Mailing Address - Street 1:18911 NORDHOFF ST STE 37
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91324-3774
Mailing Address - Country:US
Mailing Address - Phone:818-435-2800
Mailing Address - Fax:
Practice Address - Street 1:18911 NORDHOFF ST STE 37
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-3774
Practice Address - Country:US
Practice Address - Phone:818-435-2800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-16
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT13074225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHandGroup - Single Specialty