Provider Demographics
NPI:1598717241
Name:ESTOQUE, MARJORIE FAITH (OT)
Entity Type:Individual
Prefix:MRS
First Name:MARJORIE
Middle Name:FAITH
Last Name:ESTOQUE
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1465 VOYAGER DRIVE
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92782-1725
Mailing Address - Country:US
Mailing Address - Phone:949-552-1242
Mailing Address - Fax:
Practice Address - Street 1:710 GOLDEN AVE
Practice Address - Street 2:
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870-1635
Practice Address - Country:US
Practice Address - Phone:714-993-2093
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA954225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics