Provider Demographics
NPI:1760639520
Name:GUANZON, REEJEE NISNISAN (OTR)
Entity Type:Individual
Prefix:MRS
First Name:REEJEE
Middle Name:NISNISAN
Last Name:GUANZON
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MS
Other - First Name:REEJEE
Other - Middle Name:SOMOSOT
Other - Last Name:NISNISAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:512 SCENIC VIEW AVE
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46385-7967
Mailing Address - Country:US
Mailing Address - Phone:219-462-8308
Mailing Address - Fax:
Practice Address - Street 1:251 STURDY RD
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-5921
Practice Address - Country:US
Practice Address - Phone:219-462-6158
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-25
Last Update Date:2008-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31003964A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist