Healthcare Provider Details

I. General information

NPI: 1114081940
Provider Name (Legal Business Name): BILLY STIMSON MA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 SIERRA ST
EL SEGUNDO CA
90245-4117
US

IV. Provider business mailing address

2500 PACIFIC AVE
MANHATTAN BEACH CA
90266-2336
US

V. Phone/Fax

Practice location:
  • Phone: 310-426-9406
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number1179
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: