Provider Demographics
NPI:1811256639
Name:DRAGICEVICH, MILITSA MIMI (OT)
Entity type:Individual
Prefix:
First Name:MILITSA
Middle Name:MIMI
Last Name:DRAGICEVICH
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12431 MAGNOLIA ST
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92841-3321
Mailing Address - Country:US
Mailing Address - Phone:714-539-3155
Mailing Address - Fax:888-475-5771
Practice Address - Street 1:13633 VICTORY BLVD
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91401-1735
Practice Address - Country:US
Practice Address - Phone:818-988-7156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-14
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6555225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist