Provider Demographics
NPI:1164698254
Name:ALVARADO, ROBERT (COTA)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:ALVARADO
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1282 STABLER LN STE 630-311
Mailing Address - Street 2:
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95993-2625
Mailing Address - Country:US
Mailing Address - Phone:916-233-7388
Mailing Address - Fax:530-725-4358
Practice Address - Street 1:1282 STABLER LN STE 630-311
Practice Address - Street 2:
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95993-2625
Practice Address - Country:US
Practice Address - Phone:916-233-7388
Practice Address - Fax:530-725-4358
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-07
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOTA 603224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOTA 603OtherBOARD OF OCCUPATIONAL THERAPY OF CALIFORNIA