Provider Demographics
NPI:1356508774
Name:RESPICIO, MARIA (OTR/L)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:RESPICIO
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:FELICIANO
Other - Last Name:AZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:1122 E ELK AVE
Mailing Address - Street 2:# 105
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-4603
Mailing Address - Country:US
Mailing Address - Phone:818-399-5545
Mailing Address - Fax:
Practice Address - Street 1:3002 ROWENA AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90039-2005
Practice Address - Country:US
Practice Address - Phone:323-666-1544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-22
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3432225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist