Provider Demographics
NPI:1194401117
Name:VEGA, OLIVIA R (OTD, OTR/L, CHT)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:R
Last Name:VEGA
Suffix:
Gender:F
Credentials:OTD, OTR/L, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28311 VIA DEL MAR
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-6340
Mailing Address - Country:US
Mailing Address - Phone:949-973-8346
Mailing Address - Fax:
Practice Address - Street 1:16152 BEACH BLVD STE 140
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-3861
Practice Address - Country:US
Practice Address - Phone:714-556-2288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-26
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20224225X00000X, 225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist