Provider Demographics
NPI:1255456562
Name:MALANOG, JACQUILINE P (OTR)
Entity type:Individual
Prefix:
First Name:JACQUILINE
Middle Name:P
Last Name:MALANOG
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 GLENVISTA DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206-2619
Mailing Address - Country:US
Mailing Address - Phone:818-634-9580
Mailing Address - Fax:818-956-8233
Practice Address - Street 1:805 GLENVISTA DR
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91206-2619
Practice Address - Country:US
Practice Address - Phone:818-634-9580
Practice Address - Fax:818-956-8233
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2390225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist