Individual
MR. EDWARD R CASILAG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
COTA/L
Contact information
Practice address
3751 MONTGOMERY DR, SANTA ROSA, CA 95405-5214
(707) 525-1250
Mailing address
4218 EAGLES HUNT RD, MILLINGTON, TN 38053-2251
(901) 275-7945
Taxonomy
Speciality
Code
Description
License number
State
224ZF0002X
Feeding, Eating & Swallowing Occupational Therapy Assistant
Primary
OTA5372
CA
Other
Enumeration date
10/27/2020
Last updated
10/27/2020
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