Alexis Marie Codilla
Individual provider Active NPI Occupational Therapy Assistant · Mira Loma, CA
NPI 1205386752 · NPPES record last updated Oct 8, 2016
Key facts
- NPI
- 1205386752
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Occupational Therapy Assistant 224Z00000X
- License
- 3681 (CA)
- Practice address
- 6752 Leanne St
Mira Loma, CA 91752-3476 - Phone
- (951) 427-3889
- NPI assigned
- Oct 8, 2016
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3681 | CA | MD | School Psychologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapy Assistant | 224Z00000X | 3681 | CA | Yes |
Addresses
Primary practice location
6752 Leanne St
Mira Loma, CA 91752-3476
Mailing address
6752 Leanne St
Mira Loma, CA 91752-3476
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- Dawn Camille Chambers
- Sheerene Ann Consolacion
- Elaine Cook
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All providers in Mira Loma, CA · Occupational Therapy Assistant in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 8, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.