Provider Demographics
NPI:1992487805
Name:AGUILAR, MICHELLE (MOT, OTR)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:AGUILAR
Suffix:
Gender:F
Credentials:MOT, OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3548 GEORGIA ST APT 3
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-4640
Mailing Address - Country:US
Mailing Address - Phone:516-782-5028
Mailing Address - Fax:
Practice Address - Street 1:41421 DATE ST STE 101
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-7079
Practice Address - Country:US
Practice Address - Phone:855-454-3784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-01
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist