Provider Demographics
NPI:1174856850
Name:MENAKER, EMILY JACOBS (MSOTR/L)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:JACOBS
Last Name:MENAKER
Suffix:
Gender:F
Credentials:MSOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:866 GLENHAVEN AVE
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92832-1252
Mailing Address - Country:US
Mailing Address - Phone:312-420-9131
Mailing Address - Fax:
Practice Address - Street 1:866 GLENHAVEN AVE
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92832-1252
Practice Address - Country:US
Practice Address - Phone:312-420-9131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-11
Last Update Date:2009-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT9449225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics