Healthcare Provider Details

I. General information

NPI: 1629984331
Provider Name (Legal Business Name): GROWTH SPURT PEDIATRIC THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5554 THOMAS RD
SEBASTOPOL CA
95472-9377
US

IV. Provider business mailing address

5554 THOMAS RD
SEBASTOPOL CA
95472-9377
US

V. Phone/Fax

Practice location:
  • Phone: 415-297-8892
  • Fax:
Mailing address:
  • Phone: 415-297-8892
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XF0002X
TaxonomyFeeding, Eating & Swallowing Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: MS. ANYA SOLED
Title or Position: OWNER
Credential: OTR/L
Phone: 415-297-8892