Healthcare Provider Details

I. General information

NPI: 1033919899
Provider Name (Legal Business Name): MISSION PEDIATRIC THERAPY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2025
Last Update Date: 03/19/2025
Certification Date: 03/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19431 RUE DE VALORE APT 42F
FOOTHILL RANCH CA
92610-2325
US

IV. Provider business mailing address

19431 RUE DE VALORE APT 42F
FOOTHILL RANCH CA
92610-2325
US

V. Phone/Fax

Practice location:
  • Phone: 949-351-3127
  • Fax:
Mailing address:
  • Phone: 949-351-3127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: MRS. HILARY WEK
Title or Position: OCCUPATIONAL THERAPIST
Credential: OTR/L
Phone: 949-351-3127