Provider Demographics
NPI:1639567621
Name:ORCHANIAN, DENISE ANGELA (COTA)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:ANGELA
Last Name:ORCHANIAN
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 W ALLUVIAL AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-6716
Mailing Address - Country:US
Mailing Address - Phone:559-323-6200
Mailing Address - Fax:
Practice Address - Street 1:650 W ALLUVIAL AVE
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93611-6716
Practice Address - Country:US
Practice Address - Phone:559-323-6200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-30
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOTA 1558224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant