Provider Demographics
NPI:1497299747
Name:SALEM, VANESSA (COTA/L)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:SALEM
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11368 VIA RANCHO SAN DIEGO UNIT F
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92019-5210
Mailing Address - Country:US
Mailing Address - Phone:619-251-8152
Mailing Address - Fax:
Practice Address - Street 1:11368 VIA RANCHO SAN DIEGO UNIT F
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92019
Practice Address - Country:US
Practice Address - Phone:619-251-8152
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-06
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOTA 2373224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant