Provider Demographics
NPI:1659654580
Name:NOVELO, CYNTHIA (OT)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:NOVELO
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 1:12881 KNOTT ST
Mailing Address - Street 2:STE 103
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92841-3925
Mailing Address - Country:US
Mailing Address - Phone:714-892-6828
Mailing Address - Fax:714-898-9720
Practice Address - Street 1:12881 KNOTT ST
Practice Address - Street 2:STE 103
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92841-3925
Practice Address - Country:US
Practice Address - Phone:714-892-6828
Practice Address - Fax:714-898-9720
Is Sole Proprietor?:No
Enumeration Date:2011-09-27
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12132225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics