Provider Demographics
NPI:1467937797
Name:VILLARREAL, DAMIAN (COTA)
Entity Type:Individual
Prefix:
First Name:DAMIAN
Middle Name:
Last Name:VILLARREAL
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24712 MUNSON ST
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:MI
Mailing Address - Zip Code:48180-2137
Mailing Address - Country:US
Mailing Address - Phone:313-283-4832
Mailing Address - Fax:
Practice Address - Street 1:24712 MUNSON ST
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-2137
Practice Address - Country:US
Practice Address - Phone:313-283-4832
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-02
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4578224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Single Specialty