Provider Demographics
NPI: | 1376778928 |
---|---|
Name: | VILLAR, IRENE (PHD, OTR/L, SWC) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | IRENE |
Middle Name: | |
Last Name: | VILLAR |
Suffix: | |
Gender: | F |
Credentials: | PHD, OTR/L, SWC |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 50 E FOOTHILL BLVD STE 100 |
Mailing Address - Street 2: | |
Mailing Address - City: | ARCADIA |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 91006-2314 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 626-445-2400 |
Mailing Address - Fax: | 626-445-2419 |
Practice Address - Street 1: | 50 E FOOTHILL BLVD STE 100 |
Practice Address - Street 2: | |
Practice Address - City: | ARCADIA |
Practice Address - State: | CA |
Practice Address - Zip Code: | 91006-2314 |
Practice Address - Country: | US |
Practice Address - Phone: | 626-445-2400 |
Practice Address - Fax: | 626-445-2419 |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2009-05-27 |
Last Update Date: | 2009-05-27 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
CA | OT1509 | 225XP0200X, 225XF0002X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 225XP0200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Pediatrics |
No | 225XF0002X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Feeding, Eating & Swallowing |