Provider Demographics
NPI:1740847359
Name:DILAG, AINSLEY (OTR/L)
Entity type:Individual
Prefix:
First Name:AINSLEY
Middle Name:
Last Name:DILAG
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 1:18757 BURBANK BLVD STE 118
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-6345
Mailing Address - Country:US
Mailing Address - Phone:818-812-5300
Mailing Address - Fax:
Practice Address - Street 1:18757 BURBANK BLVD STE 118
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-6345
Practice Address - Country:US
Practice Address - Phone:818-812-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-20
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26694225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist