Yevgeny Edd Jozef Marababol Medalle, OTR/L

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

25642 Issued in CA

Practice address

3300 E South St Ste 203
Lakewood, CA 90805-4589

Phone

(562) 512-3320

NPI assigned

Feb 29, 2024

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Functional Rehabilitation Physical Therapy PC

  • Physical Therapy Clinic/Center
  • Lakewood, CA
  • NPI 1063083723
  Medicare reassignment NPD
• Rehabilitation Dynamics Inc

  • Physical Therapist
  • Lakewood, CA
  • NPI 1548460157

  Occupational Therapist

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1709164800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709164800000",
    "number": "1124885843",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4308 E 4TH ST APT 8",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908144948",
            "telephone_number": "408-250-4870"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3300 E SOUTH ST STE 203",
            "city": "LAKEWOOD",
            "state": "CA",
            "postal_code": "908054589",
            "telephone_number": "562-512-3320"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEDALLE",
        "first_name": "YEVGENY EDD JOZEF",
        "middle_name": "MARABABOL",
        "credential": "OTR/L",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-02-29",
        "last_updated": "2024-02-29",
        "certification_date": "2024-02-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "CA",
            "license": "25642",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mia McKellar
• Elstree Rose McMillan
• Danyel Nicole McQuinn, M.A.
• Amber Jasmine McWha
• MD Surgical
• Medical Diagnostic and Prognostic Laboratory
• Medical Resource Inc
• Rocio Medina
• Amaturrahman Medlock
• Cynthia Meggers, M.S. CCC-SLP

• Occupational Therapist in Lakewood, CA
• Providers in Lakewood, CA by specialty
• Occupational Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 29, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.