Provider Demographics
NPI:1982764239
Name:PANGILINAN, MILDRED (OTR-L)
Entity Type:Individual
Prefix:
First Name:MILDRED
Middle Name:
Last Name:PANGILINAN
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 1:3341 E QUEEN CREEK RD
Mailing Address - Street 2:SUITE 109
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85297-8503
Mailing Address - Country:US
Mailing Address - Phone:480-621-8361
Mailing Address - Fax:480-621-8513
Practice Address - Street 1:3341 E QUEEN CREEK RD
Practice Address - Street 2:SUITE 109
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-8503
Practice Address - Country:US
Practice Address - Phone:480-621-8361
Practice Address - Fax:480-621-8513
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-09
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3028225X00000X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ806622Medicaid