Provider Demographics
NPI:1881208999
Name:CARAVELLI, ANTHONY PHILLIP (OTR)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:PHILLIP
Last Name:CARAVELLI
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:945 OTAY LAKES RD STE E
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91913-3055
Mailing Address - Country:US
Mailing Address - Phone:619-997-4335
Mailing Address - Fax:
Practice Address - Street 1:945 OTAY LAKES RD STE E
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91913-3055
Practice Address - Country:US
Practice Address - Phone:619-997-4335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-04
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1000171225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty