MEDICARE: HAND TO SHOULDER REHAB, INC.

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225XE1200X	Ergonomics Occupational Therapist
2	225XH1200X	Hand Occupational Therapist	1011100174	CA
3	225X00000X	Occupational Therapist	OT397	CA

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	CT9956620	OTHER	CA	MEDICARE

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ZZZ04873Z	OTHER	CA	BLUE CROSS/BLUE SHIELD
2	24482484	OTHER	CA	BPNSE TPIN
3	CA-2255-0304	OTHER	CA	PREFERRED THERAPY PROVS.
5	131116	OTHER	WA	STATE DEPT. OF LABOR

NPI Number	:	1972502300
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAND TO SHOULDER REHAB, INC.

Provider Business Mailing Address
First Line	:	7005 N MAPLE AVE
Second Line	:	SUITE 104
City	:	FRESNO
State	:	CA
Zip	:	93720-8009
Country	:	US
Telephone Number	:	559-325-3503
Fax Number	:	559-325-3504

Provider Business Practice Location Address
First Line	:	7005 N MAPLE AVE
Second Line	:	SUITE 104
City	:	FRESNO
State	:	CA
Zip	:	93720-8009
Country	:	US
Telephone Number	:	559-325-3503
Fax Number	:	559-325-3504

Authorized Official
Title or Position	:	CEO / PRESIDENT
Name	:	MRS. KAREN LINDSAY PIMENTEL
Credential	:	OTR/L,CHT,CWCE,CEAS
Telephone Number	:	559-325-3503

Provider Enumeration Date	:	07/18/2005
Last Update Date	:	11/28/2007

7005 N MAPLE AVE STE 108
FRESNO, CA
93720-8009

Practice Phone: 559-325-3832
Practice Fax: 559-325-2603

7005 N MAPLE AVE , #104
FRESNO, CA
93720-8009