Healthcare Provider Details

I. General information

NPI: 1669610085
Provider Name (Legal Business Name): REDWOOD PEDIATRIC THERAPY ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2009
Last Update Date: 01/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 TESCONI CIR SUITE C
SANTA ROSA CA
95401-4676
US

IV. Provider business mailing address

340 TESCONI CIR SUITE C
SANTA ROSA CA
95401-4676
US

V. Phone/Fax

Practice location:
  • Phone: 707-546-9160
  • Fax: 707-546-1338
Mailing address:
  • Phone: 707-546-9160
  • Fax: 707-546-1338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225XF0002X
TaxonomyFeeding, Eating & Swallowing Occupational Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: MS. KAREN SMITH
Title or Position: PRESIDENT
Credential: OTR/L
Phone: 707-546-9160