Provider Demographics
NPI:1851621817
Name:BAGULBAGUL, JOANNE (OTR/L)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:
Last Name:BAGULBAGUL
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20211 SHERMAN WAY APT 222
Mailing Address - Street 2:
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91306-3292
Mailing Address - Country:US
Mailing Address - Phone:818-274-1687
Mailing Address - Fax:
Practice Address - Street 1:433 N 4TH ST STE 101
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-4313
Practice Address - Country:US
Practice Address - Phone:323-722-8610
Practice Address - Fax:323-722-8614
Is Sole Proprietor?:No
Enumeration Date:2010-01-13
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10372225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics