Provider Demographics
NPI:1659706539
Name:FABIAN, RENEE MARIE MORONES (OTR)
Entity Type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:MARIE MORONES
Last Name:FABIAN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:359 SHORE VIEW LN
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-1761
Mailing Address - Country:US
Mailing Address - Phone:310-698-2178
Mailing Address - Fax:
Practice Address - Street 1:1947 CAMINO VIDA ROBLE
Practice Address - Street 2:SUITE 230
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-6540
Practice Address - Country:US
Practice Address - Phone:760-918-9500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-10
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT7350225X00000X, 225XF0002X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XF0002XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistFeeding, Eating & Swallowing
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics