Provider Demographics
NPI:1205873148
Name:MESCH, DORIS A (OTR/L)
Entity type:Individual
Prefix:
First Name:DORIS
Middle Name:A
Last Name:MESCH
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 1:3525 LOMA VISTA RD
Mailing Address - Street 2:STE A
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-3101
Mailing Address - Country:US
Mailing Address - Phone:805-804-4165
Mailing Address - Fax:805-641-6495
Practice Address - Street 1:2525 ERRINGER RD
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-2352
Practice Address - Country:US
Practice Address - Phone:805-524-1404
Practice Address - Fax:805-527-5246
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15831225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL056001745OtherLICENSE
ILK16375Medicare ID - Type Unspecified
CAW268Medicare PIN