Healthcare Provider Details

I. General information

NPI: 1174765077
Provider Name (Legal Business Name): LINDA J HURST OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2009
Last Update Date: 03/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3130 BONITA RD SUITE 100
CHULA VISTA CA
91910-3263
US

IV. Provider business mailing address

3444 KEARNY VILLA RD SUITE 200
SAN DIEGO CA
92123-1959
US

V. Phone/Fax

Practice location:
  • Phone: 619-585-7104
  • Fax: 619-585-7106
Mailing address:
  • Phone: 888-208-8526
  • Fax: 858-751-0901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT3721
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: