Provider Demographics
NPI:1699369462
Name:ABRERA, ARTURO ITCHON JR (OTR/L, CNS, CPAM,)
Entity Type:Individual
Prefix:
First Name:ARTURO
Middle Name:ITCHON
Last Name:ABRERA
Suffix:JR
Gender:M
Credentials:OTR/L, CNS, CPAM,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9107 DAVIS RD
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95209-1807
Mailing Address - Country:US
Mailing Address - Phone:209-478-6488
Mailing Address - Fax:
Practice Address - Street 1:9107 DAVIS RD
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95209-1807
Practice Address - Country:US
Practice Address - Phone:209-478-6488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-23
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18881225X00000X, 225XN1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitation
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist