Provider Demographics
NPI:1528567922
Name:MILICEVIC, MARIJA ANTONIJA
Entity Type:Individual
Prefix:
First Name:MARIJA
Middle Name:ANTONIJA
Last Name:MILICEVIC
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 KING ST UNIT 705
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94107-4912
Mailing Address - Country:US
Mailing Address - Phone:650-248-8131
Mailing Address - Fax:
Practice Address - Street 1:170 KING ST UNIT 705
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94107-4912
Practice Address - Country:US
Practice Address - Phone:650-248-8131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-12
Last Update Date:2018-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11511225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty