Healthcare Provider Details

I. General information

NPI: 1639181811
Provider Name (Legal Business Name): STOCKTON HAND THERAPY & REHABILITATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 09/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 GRAND CANAL BLVD SUITE C4
STOCKTON CA
95207-8114
US

IV. Provider business mailing address

7824 SOUTHWORTH RD
VALLEY SPRINGS CA
95252-8971
US

V. Phone/Fax

Practice location:
  • Phone: 209-956-8737
  • Fax: 209-956-2586
Mailing address:
  • Phone: 209-956-8737
  • Fax: 209-956-2586

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number2470
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License Number2470
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2470
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number2470
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License Number2470
License Number StateCA

VIII. Authorized Official

Name: MS. MARIANNE RENEE CABALLERO-RODRIGUEZ
Title or Position: PRESIDENT
Credential: OT/L, CHT
Phone: 209-956-8737