Provider Demographics
NPI:1013601731
Name:CESA, MARIELLE CABUHAT (MAOT, OTR/L)
Entity Type:Individual
Prefix:
First Name:MARIELLE
Middle Name:CABUHAT
Last Name:CESA
Suffix:
Gender:F
Credentials:MAOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31987 CALABAZA CT
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-6286
Mailing Address - Country:US
Mailing Address - Phone:323-528-0255
Mailing Address - Fax:
Practice Address - Street 1:2795 CABOT DR STE 6-115
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92883-7377
Practice Address - Country:US
Practice Address - Phone:951-340-0431
Practice Address - Fax:951-893-5135
Is Sole Proprietor?:No
Enumeration Date:2023-06-06
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24882225XP0200X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics