Provider Demographics
NPI:1598921207
Name:GAMIAO, RODERICK (OTR)
Entity Type:Individual
Prefix:
First Name:RODERICK
Middle Name:
Last Name:GAMIAO
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2222 FOOTHILL BLVD
Mailing Address - Street 2:#E553
Mailing Address - City:LA CANADA
Mailing Address - State:CA
Mailing Address - Zip Code:91011-1456
Mailing Address - Country:US
Mailing Address - Phone:818-920-9474
Mailing Address - Fax:818-920-9473
Practice Address - Street 1:14427 CHASE ST
Practice Address - Street 2:SUITE 206
Practice Address - City:PANORAMA CITY
Practice Address - State:CA
Practice Address - Zip Code:91402-3020
Practice Address - Country:US
Practice Address - Phone:818-920-9474
Practice Address - Fax:818-920-9473
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-01
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT3250225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist