Healthcare Provider Details

I. General information

NPI: 1972991834
Provider Name (Legal Business Name): CECILIA CRAIG OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CECILIA QUINN OTR/L

II. Dates (important events)

Enumeration Date: 12/30/2014
Last Update Date: 09/09/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 W HOSPITALITY LN STE 103
SAN BERNARDINO CA
92408-3238
US

IV. Provider business mailing address

PO BOX 1186
ONTARIO CA
91762-0186
US

V. Phone/Fax

Practice location:
  • Phone: 909-567-2221
  • Fax: 909-763-3216
Mailing address:
  • Phone: 909-418-8663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number2984
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number22395
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: