Basic Information
Provider Information
NPI: 1366984049
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ABSI
FirstName: MARIA
MiddleName: ANGELA
NamePrefix: MRS.
NameSuffix:  
Credential: OTR/L
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 120 W WILSON AVE
Address2: UNIT 1440
City: GLENDALE
State: CA
PostalCode: 912031884
CountryCode: US
TelephoneNumber: 9095757821
FaxNumber:  
Practice Location
Address1: 12411 SLAUSON AVE
Address2:  
City: WHITTIER
State: CA
PostalCode: 906062835
CountryCode: US
TelephoneNumber: 5626935449
FaxNumber:  
Other Information
ProviderEnumerationDate: 11/10/2016
LastUpdateDate: 11/10/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225X00000X16865CAY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist 

No ID Information.


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