Provider Demographics
NPI:1417960329
Name:LOUWERSE, MARGO MARIE TOFT (OTR/L, CHT)
Entity Type:Individual
Prefix:MS
First Name:MARGO
Middle Name:MARIE TOFT
Last Name:LOUWERSE
Suffix:
Gender:F
Credentials:OTR/L, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 TESCONI CIR
Mailing Address - Street 2:SUITE G
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95401-4611
Mailing Address - Country:US
Mailing Address - Phone:707-544-2637
Mailing Address - Fax:707-544-2088
Practice Address - Street 1:320 TESCONI CIR
Practice Address - Street 2:SUITE G
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-4611
Practice Address - Country:US
Practice Address - Phone:707-544-2637
Practice Address - Fax:707-544-2088
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2009-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT467225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ04554ZMedicare PIN