Provider Demographics
NPI:1164677795
Name:MAPALO, AILEEN (OT)
Entity Type:Individual
Prefix:
First Name:AILEEN
Middle Name:
Last Name:MAPALO
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:AILEEN
Other - Middle Name:
Other - Last Name:ABREA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1628 JOHN F KENNEDY BLVD STE 401
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-2120
Mailing Address - Country:US
Mailing Address - Phone:215-557-0057
Mailing Address - Fax:
Practice Address - Street 1:1628 JOHN F KENNEDY BLVD STE 401
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-2120
Practice Address - Country:US
Practice Address - Phone:215-557-0057
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-24
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCOT010000537225X00000X
VA0119004668225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist