Healthcare Provider Details

I. General information

NPI: 1487586251
Provider Name (Legal Business Name): SUMMIT PEDIATRIC OCCUPATIONAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 05/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6745 SHAW AVE
MT BALDY CA
91759
US

IV. Provider business mailing address

PO BOX 595
MT BALDY CA
91759-0595
US

V. Phone/Fax

Practice location:
  • Phone: 626-506-7393
  • Fax:
Mailing address:
  • Phone: 626-506-7393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: KRISTINA L EGBERT
Title or Position: OWNER
Credential: OTR/L
Phone: 626-506-7393