IndividualActive
Modesto King Andrew Formilleza, OTR
NPI 1285944561 · Physical Rehabilitation Occupational Therapist · Creswell, OR
Provider details
- NPI number
- 1285944561
- Entity type
- Individual
- Primary specialty
- Physical Rehabilitation Occupational TherapistRespiratory, Developmental, Rehabilitative and Restorative Service Providers
- Credential
- OTR
- Sex
- Male
- Sole proprietor
- No
- License
- 260743 (OR)
Specialties & taxonomies
Respiratory, Developmental, Rehabilitative and Restorative Service Providers
Practice location
735 S 2nd St
Creswell, OR 97426-7507
Phone: (541) 895-3333
Approximate (ZIP-level) locationGet directions
Mailing address
4001 Potter St Apt 47
Eugene, OR 97405-4583
Registry dates
- Enumerated
- 2010-10-20
- Last updated
- 2010-10-20
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.