Provider Demographics
NPI:1033675483
Name:GRULLON, EMILY DOLORES (OTD, OTR)
Entity Type:Individual
Prefix:DR
First Name:EMILY
Middle Name:DOLORES
Last Name:GRULLON
Suffix:
Gender:F
Credentials:OTD, OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:289 W HUNTINGTON DR STE 103
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91007-3492
Mailing Address - Country:US
Mailing Address - Phone:626-396-8150
Mailing Address - Fax:
Practice Address - Street 1:289 W HUNTINGTON DR STE 103
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-3492
Practice Address - Country:US
Practice Address - Phone:626-396-8150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-11
Last Update Date:2019-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA19710225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program