Modesto King Andrew Esguerra Formilleza V, OTR
Individual provider Active NPI Physical Rehabilitation Occupational Therapist · Creswell, OR
NPI 1285944561 · NPPES record last updated Oct 20, 2010
Key facts
- NPI
- 1285944561
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Rehabilitation Occupational Therapist 225XP0019X
- License
- 260743 (OR)
- Practice address
- 735 S 2ND St
Creswell, OR 97426-7507 - Phone
- (541) 895-3333
- NPI assigned
- Oct 20, 2010
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|
| 260743 | OR | MD | Physical Rehabilitation Occupational Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Rehabilitation Occupational Therapist | 225XP0019X | 260743 | OR | Yes |
Addresses
Primary practice location
735 S 2ND St
Creswell, OR 97426-7507
Mailing address
4001 Potter St Apt 47
Eugene, OR 97405-4583
Phone (541) 912-5595
Other providers in Creswell, OR
- Emerald Valley Physical Therapy, P.C.
- Emerald Valley RX, LLC
- Emerald Valley RX, LLC
- Emerald Wellness, P.C.
- Eyeland Family Optical LLC
- Patrick E Freuen
- Rhonda Garcia Mondragon
- Andrea Marie Gifford
- Jessica Renee Greene
- Joseph R Greenwood
All providers in Creswell, OR · Physical Rehabilitation Occupational Therapist in Oregon
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 20, 2010. 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.