Provider Demographics
NPI:1962878496
Name:ESCARCEGA, IVETTE (COTA)
Entity type:Individual
Prefix:
First Name:IVETTE
Middle Name:
Last Name:ESCARCEGA
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3409 NE 62ND AVE
Mailing Address - Street 2:APT 55
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98661-0207
Mailing Address - Country:US
Mailing Address - Phone:915-207-3924
Mailing Address - Fax:
Practice Address - Street 1:3409 NE 62 AVE
Practice Address - Street 2:APT 55
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661
Practice Address - Country:US
Practice Address - Phone:915-207-3924
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-19
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR311748224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant