Provider Demographics
NPI:1114600665
Name:MACASAET, TRISTENNE OCAMPO (OTRL)
Entity Type:Individual
Prefix:MRS
First Name:TRISTENNE
Middle Name:OCAMPO
Last Name:MACASAET
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:MS
Other - First Name:TRISTENNE
Other - Middle Name:VICENCIO
Other - Last Name:OCAMPO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTRL
Mailing Address - Street 1:10052 FARRALONE AVE
Mailing Address - Street 2:
Mailing Address - City:CHATSWORTH
Mailing Address - State:CA
Mailing Address - Zip Code:91311-2708
Mailing Address - Country:US
Mailing Address - Phone:818-301-9220
Mailing Address - Fax:
Practice Address - Street 1:10052 FARRALONE AVE
Practice Address - Street 2:
Practice Address - City:CHATSWORTH
Practice Address - State:CA
Practice Address - Zip Code:91311-2708
Practice Address - Country:US
Practice Address - Phone:818-301-9220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-10
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA482079225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist