Healthcare Provider Details

I. General information

NPI: 1164355459
Provider Name (Legal Business Name): OT THE WAY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

11799 SEBASTIAN WAY STE 103
RANCHO CUCAMONGA CA
91730-0708
US

IV. Provider business mailing address

11799 SEBASTIAN WAY STE 103
RANCHO CUCAMONGA CA
91730-0708
US

V. Phone/Fax

Practice location:
  • Phone: 909-493-6735
  • Fax:
Mailing address:
  • Phone: 909-493-6735
  • 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: JACQUELINE HARDISON
Title or Position: CO-FOUNDER, OCCUPATIONAL THERAPIST
Credential: OTR/L
Phone: 909-973-4162