Provider Demographics
NPI:1346465705
Name:NEVILLE, PATRICIA ANN (OTRL)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:ANN
Last Name:NEVILLE
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:MRS
Other - First Name:PATRICIA
Other - Middle Name:ANN
Other - Last Name:MCCLURE NEVILLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTRL
Mailing Address - Street 1:33672 ANGELES DRIVE
Mailing Address - Street 2:P.O.BOX 8181
Mailing Address - City:GREEN VALLEY LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:92341-8181
Mailing Address - Country:US
Mailing Address - Phone:909-867-2995
Mailing Address - Fax:
Practice Address - Street 1:9161 SIERRA AVE.
Practice Address - Street 2:SUITE 111
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335
Practice Address - Country:US
Practice Address - Phone:909-427-4073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5295225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics