Provider Demographics
NPI:1720309156
Name:ESCOBAR, OSCAR A (OTR)
Entity type:Individual
Prefix:
First Name:OSCAR
Middle Name:A
Last Name:ESCOBAR
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5800 FAIRFIELD AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46807-3450
Mailing Address - Country:US
Mailing Address - Phone:260-744-5585
Mailing Address - Fax:260-744-5586
Practice Address - Street 1:5800 FAIRFIELD AVE STE 150
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46807-3450
Practice Address - Country:US
Practice Address - Phone:260-744-5585
Practice Address - Fax:260-744-5586
Is Sole Proprietor?:No
Enumeration Date:2010-06-21
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31004896A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist