Provider Demographics
NPI:1164156410
Name:PURINO, MA THERESA LOURDES ARZAGA (COTA/L)
Entity Type:Individual
Prefix:
First Name:MA THERESA LOURDES
Middle Name:ARZAGA
Last Name:PURINO
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2910 RESERVOIR LN
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002-1203
Mailing Address - Country:US
Mailing Address - Phone:201-790-7779
Mailing Address - Fax:
Practice Address - Street 1:3550 CHURN CREEK RD
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-2718
Practice Address - Country:US
Practice Address - Phone:530-222-3630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-12
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOTA5328224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant