Healthcare Provider Details

I. General information

NPI: 1154647592
Provider Name (Legal Business Name): OT SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2010
Last Update Date: 04/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5917 OAK AVE PMB 121
TEMPLE CITY CA
91780-2028
US

IV. Provider business mailing address

5917 OAK AVE PMB 121
TEMPLE CITY CA
91780-2028
US

V. Phone/Fax

Practice location:
  • Phone: 626-287-1723
  • Fax: 626-791-4662
Mailing address:
  • Phone: 626-287-1723
  • Fax: 626-791-4662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number1888
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number1888
License Number StateCA

VIII. Authorized Official

Name: FAITH REPKE
Title or Position: PRESIDENT
Credential:
Phone: 626-287-1723