Provider Demographics
NPI:1386982353
Name:RESTIVO, ELIZABETH KPACHAVI (OTD)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:KPACHAVI
Last Name:RESTIVO
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15053 BLACKHAWK ST
Mailing Address - Street 2:
Mailing Address - City:MISSION HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91345-2501
Mailing Address - Country:US
Mailing Address - Phone:818-618-8455
Mailing Address - Fax:
Practice Address - Street 1:10716 LA TUNA CANYON RD
Practice Address - Street 2:
Practice Address - City:SUN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91352-2130
Practice Address - Country:US
Practice Address - Phone:818-252-5863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-24
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14905225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist