Healthcare Provider Details

I. General information

NPI: 1669873295
Provider Name (Legal Business Name): CAROLINE SHIN MS, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2014
Last Update Date: 07/18/2025
Certification Date: 07/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

249 E OCEAN BLVD STE 400
LONG BEACH CA
90802-4806
US

IV. Provider business mailing address

817 W BEACON ST APT B
ALHAMBRA CA
91801-3648
US

V. Phone/Fax

Practice location:
  • Phone: 888-808-7838
  • Fax:
Mailing address:
  • Phone: 323-702-8585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number13413
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: