Provider Demographics
NPI:1235114414
Name:MANALE, ESTEBAN (OT)
Entity Type:Individual
Prefix:
First Name:ESTEBAN
Middle Name:
Last Name:MANALE
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:STEPHEN
Other - Middle Name:
Other - Last Name:MANALE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7340 FIRESTONE BLVD
Mailing Address - Street 2:# 123
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90241-4100
Mailing Address - Country:US
Mailing Address - Phone:323-793-6931
Mailing Address - Fax:323-721-3396
Practice Address - Street 1:7340 FIRESTONE BLVD
Practice Address - Street 2:STE. 123
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-4100
Practice Address - Country:US
Practice Address - Phone:562-927-5820
Practice Address - Fax:323-721-3396
Is Sole Proprietor?:No
Enumeration Date:2005-12-12
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT5243225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist