Provider Demographics
NPI:1164541157
Name:MILOSEVICH, MARY JEANNE (OTR/L)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:JEANNE
Last Name:MILOSEVICH
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:JEANNE
Other - Last Name:ZIMMERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1115 WEST AVE. M-14
Mailing Address - Street 2:WEST POINT PHYSICAL THERAPY, INC
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551
Mailing Address - Country:US
Mailing Address - Phone:661-265-0060
Mailing Address - Fax:661-265-0199
Practice Address - Street 1:68845 PEREZ RD
Practice Address - Street 2:STE H-6
Practice Address - City:CATHEDRAL CITY
Practice Address - State:CA
Practice Address - Zip Code:92234-7254
Practice Address - Country:US
Practice Address - Phone:760-328-0292
Practice Address - Fax:760-328-9563
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4308225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist