Healthcare Provider Details

I. General information

NPI: 1235920646
Provider Name (Legal Business Name): ISAIAH STUARD OTR/L
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2025
Last Update Date: 05/14/2025
Certification Date: 05/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

943 N GRAND AVE
COVINA CA
91724-2046
US

IV. Provider business mailing address

809 BRIDLE DR
DIAMOND BAR CA
91765-1950
US

V. Phone/Fax

Practice location:
  • Phone: 626-671-6100
  • Fax:
Mailing address:
  • Phone: 909-282-2081
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number27427
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: