Provider Demographics
NPI:1356161863
Name:MORALEZ, MIA (OTD,OTR/L)
Entity type:Individual
Prefix:
First Name:MIA
Middle Name:
Last Name:MORALEZ
Suffix:
Gender:F
Credentials:OTD,OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3700 GOSFORD RD STE G
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-7694
Mailing Address - Country:US
Mailing Address - Phone:661-832-9737
Mailing Address - Fax:661-832-9738
Practice Address - Street 1:3700 GOSFORD RD STE G
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-7694
Practice Address - Country:US
Practice Address - Phone:661-832-9737
Practice Address - Fax:661-832-9738
Is Sole Proprietor?:No
Enumeration Date:2024-10-10
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27016225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist