Provider Demographics
NPI:1548265564
Name:CASTILLO, RUTH NINA DIMALANTA (MS, OTR/L)
Entity type:Individual
Prefix:
First Name:RUTH NINA
Middle Name:DIMALANTA
Last Name:CASTILLO
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 E WARNER RD STE 106
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-1057
Mailing Address - Country:US
Mailing Address - Phone:480-577-7941
Mailing Address - Fax:480-963-5805
Practice Address - Street 1:815 E WARNER RD STE 106
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-1057
Practice Address - Country:US
Practice Address - Phone:480-577-7941
Practice Address - Fax:480-963-5805
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2993225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist