Healthcare Provider Details

I. General information

NPI: 1396497020
Provider Name (Legal Business Name): PAIGE MATTHEW ALEXIS BUSH MSOT, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2022
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23100 EUCALYPTUS AVE STE C
MORENO VALLEY CA
92553-5439
US

IV. Provider business mailing address

23100 EUCALYPTUS AVE STE C
MORENO VALLEY CA
92553-5439
US

V. Phone/Fax

Practice location:
  • Phone: 951-379-1500
  • Fax: 951-379-1501
Mailing address:
  • Phone: 909-230-8730
  • Fax: 951-379-1501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number29335
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number73782
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: