Provider Demographics
NPI:1972190957
Name:OTAKY, ABEER (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ABEER
Middle Name:
Last Name:OTAKY
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 E FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006-2549
Mailing Address - Country:US
Mailing Address - Phone:909-524-2104
Mailing Address - Fax:
Practice Address - Street 1:301 E FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-2549
Practice Address - Country:US
Practice Address - Phone:626-538-2751
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-24
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15289235Z00000X
CA33154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA33154OtherSPEECH-LANGUAGE PATHOLOGY, AUDIOLOGY & HEARING AID DISPENSERS BOARD
CA15289OtherSPEECH-LANGUAGE PATHOLOGY, AUDIOLOGY & HEARING AID DISPENSERS BOARD