Healthcare Provider Details

I. General information

NPI: 1902116916
Provider Name (Legal Business Name): APPLE TREE EARLY INTERVENTION CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2010
Last Update Date: 12/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5851 NEWMAN ST
CYPRESS CA
90630-3322
US

IV. Provider business mailing address

5851 NEWMAN ST
CYPRESS CA
90630-3322
US

V. Phone/Fax

Practice location:
  • Phone: 714-826-4957
  • Fax: 714-489-2191
Mailing address:
  • Phone: 714-826-4957
  • Fax: 714-489-2191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number33159
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number16710
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number2034
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number18852
License Number StateCA
# 7
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number9463
License Number StateCA

VIII. Authorized Official

Name: CAROL ANNETTE THOMPSON
Title or Position: PROGRAM DIRECTOR/CEO/CO-FOUNDER
Credential:
Phone: 714-310-0883