Provider Demographics
NPI:1801211313
Name:ESCOBAR, MERI (OTR/L,MLD)
Entity Type:Individual
Prefix:
First Name:MERI
Middle Name:
Last Name:ESCOBAR
Suffix:
Gender:F
Credentials:OTR/L,MLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 KENTWORTH
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92602-0110
Mailing Address - Country:US
Mailing Address - Phone:714-812-0064
Mailing Address - Fax:714-505-0011
Practice Address - Street 1:39 KENTWORTH
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92602-0110
Practice Address - Country:US
Practice Address - Phone:714-812-0064
Practice Address - Fax:714-505-0011
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-20
Last Update Date:2014-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT887225XG0600X, 225XN1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology
No225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOT887OtherOCCUPATIONAL THERAPY LICENSE