Basic Information
| Provider Information | |||||||||
| NPI: | 1205432663 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | AYRES | ||||||||
| FirstName: | DEVON | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7366 MISSION TRAILS DR APT 13 | ||||||||
| Address2: | |||||||||
| City: | SANTEE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920713390 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7602074171 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5945 PACIFIC CENTER BLVD STE 510 | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921216305 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8586959444 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/09/2020 | ||||||||
| LastUpdateDate: | 12/09/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 21878 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
ID Information
| ID | Type | State | Issuer | Description | 21878 | 01 | CBOT | OTHER | 446136 | 01 | NBCOT | OTHER |