Provider Demographics
NPI:1649991753
Name:DEOCARIZA, GERALD ANGELO CABALLERO JR (OTD, OTR/L)
Entity type:Individual
Prefix:DR
First Name:GERALD ANGELO
Middle Name:CABALLERO
Last Name:DEOCARIZA
Suffix:JR
Gender:M
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:GERALD
Other - Middle Name:
Other - Last Name:DEOCARIZA
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:OTD, OTR/L
Mailing Address - Street 1:2717 N BOEING RD
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99206
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:411 W HAYCRAFT AVE STE D1
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83815-8104
Practice Address - Country:US
Practice Address - Phone:208-664-2468
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-07
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDOT-2642225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist