Healthcare Provider Details

I. General information

NPI: 1700795721
Provider Name (Legal Business Name): TIED TOGETHER OCCUPATIONAL THERAPY, PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23606 VIA NAVARRA
MISSION VIEJO CA
92691-3636
US

IV. Provider business mailing address

23606 VIA NAVARRA
MISSION VIEJO CA
92691-3636
US

V. Phone/Fax

Practice location:
  • Phone: 619-994-0699
  • Fax:
Mailing address:
  • Phone: 619-994-0699
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: OLIVIA ROSE EDMONDSON
Title or Position: PRESIDENT
Credential:
Phone: 619-994-0699