Healthcare Provider Details

I. General information

NPI: 1730098641
Provider Name (Legal Business Name): OLIVE GROVE OCCUPATIONAL THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 E FOOTHILL BLVD STE 208
ARCADIA CA
91006-2335
US

IV. Provider business mailing address

3961 VIA MARISOL APT 105
LOS ANGELES CA
90042-5076
US

V. Phone/Fax

Practice location:
  • Phone: 626-214-8498
  • Fax:
Mailing address:
  • Phone: 626-214-8498
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: TIFFANY MANZINI
Title or Position: OWNER
Credential:
Phone: 626-214-8498