Healthcare Provider Details

I. General information

NPI: 1699219394
Provider Name (Legal Business Name): THE CENTER FOR CONNECTION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2016
Last Update Date: 12/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1021 E WALNUT ST SUITE 200
PASADENA CA
91106-1453
US

IV. Provider business mailing address

1021 E WALNUT ST SUITE 200
PASADENA CA
91106-1453
US

V. Phone/Fax

Practice location:
  • Phone: 626-365-1211
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XF0002X
TaxonomyFeeding, Eating & Swallowing Occupational Therapist
License Number12477
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number12477
License Number StateCA

VIII. Authorized Official

Name: DR. TINA PAYNE BRYSON
Title or Position: EXECUTIVE DIRECTOR
Credential: PHD
Phone: 626-372-1809