Individual
MR. MODESTO KING ANDREW ESGUERRA FORMILLEZA V
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OTR
Contact information
Practice address
735 S 2ND ST, CRESWELL, OR 97426-7507
(541) 895-3333
Mailing address
4001 POTTER ST APT 47, EUGENE, OR 97405-4583
(541) 912-5595
Taxonomy
Speciality
Code
Description
License number
State
225XP0019X
Physical Rehabilitation Occupational Therapist
Primary
260743
OR
Other
Enumeration date
10/20/2010
Last updated
10/20/2010
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