Provider Demographics
NPI:1124586441
Name:REZVANI, CELINE SABA (OTR/L)
Entity Type:Individual
Prefix:
First Name:CELINE
Middle Name:SABA
Last Name:REZVANI
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 WOOLSEY ST
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-1832
Mailing Address - Country:US
Mailing Address - Phone:317-989-9980
Mailing Address - Fax:
Practice Address - Street 1:1000 S FREMONT AVE UNIT 27
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91803-8849
Practice Address - Country:US
Practice Address - Phone:626-289-7472
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-05
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician