Provider Demographics
NPI:1760524771
Name:CADEAUX, LILI (OTR, CHT)
Entity Type:Individual
Prefix:
First Name:LILI
Middle Name:
Last Name:CADEAUX
Suffix:
Gender:F
Credentials:OTR, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19860 TRACE RD
Mailing Address - Street 2:
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370-8425
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14255 MONO WAY
Practice Address - Street 2:SUITE B
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-8654
Practice Address - Country:US
Practice Address - Phone:209-533-0412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT1100225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ23475ZMedicare ID - Type Unspecified