Provider Demographics
NPI:1851479026
Name:COPUACO, MONINA GANALON (OTR)
Entity Type:Individual
Prefix:
First Name:MONINA
Middle Name:GANALON
Last Name:COPUACO
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 304
Mailing Address - Street 2:
Mailing Address - City:MOFFETT FIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94035-0304
Mailing Address - Country:US
Mailing Address - Phone:650-852-1228
Mailing Address - Fax:650-852-0102
Practice Address - Street 1:3401 EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94306-2805
Practice Address - Country:US
Practice Address - Phone:650-852-1228
Practice Address - Fax:650-852-0102
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT5750225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand