Provider Demographics
NPI:1356357776
Name:ASENCIO, ADRIAN MARTIN (OTL/R)
Entity type:Individual
Prefix:MR
First Name:ADRIAN
Middle Name:MARTIN
Last Name:ASENCIO
Suffix:
Gender:M
Credentials:OTL/R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 E. ENOS DR.
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454
Mailing Address - Country:US
Mailing Address - Phone:805-928-8257
Mailing Address - Fax:805-349-7206
Practice Address - Street 1:820 E. ENOS DR.
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454
Practice Address - Country:US
Practice Address - Phone:805-928-8257
Practice Address - Fax:805-349-7206
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT5725225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOT5725OtherSTATE LICENSE NUMBER