Provider Demographics
NPI:1295905156
Name:PEDRINA, RICHEL OTAYDE (OTR/L)
Entity type:Individual
Prefix:MR
First Name:RICHEL
Middle Name:OTAYDE
Last Name:PEDRINA
Suffix:
Gender:M
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 1:9 CAMBRIDGE CT APT 1
Mailing Address - Street 2:
Mailing Address - City:MICHIGAN CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46360-1594
Mailing Address - Country:US
Mailing Address - Phone:574-721-1097
Mailing Address - Fax:
Practice Address - Street 1:802 E US HIGHWAY 20
Practice Address - Street 2:
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360-7424
Practice Address - Country:US
Practice Address - Phone:219-861-3121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-07
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31004521A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist