Provider Demographics
NPI:1376671446
Name:ENGQUIST, DOUGLAS EDWARD (OTR)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:EDWARD
Last Name:ENGQUIST
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30834 HILLVIEW DR
Mailing Address - Street 2:
Mailing Address - City:VALLEY CENTER
Mailing Address - State:CA
Mailing Address - Zip Code:92082-3433
Mailing Address - Country:US
Mailing Address - Phone:760-751-1172
Mailing Address - Fax:
Practice Address - Street 1:420 FALCONER RD
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92027-5331
Practice Address - Country:US
Practice Address - Phone:760-432-2296
Practice Address - Fax:760-432-9419
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3085225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics