Healthcare Provider Details

I. General information

NPI: 1902110331
Provider Name (Legal Business Name): HAND THERAPY CENTER OF THE SOUTH BAY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2010
Last Update Date: 05/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19000 HAWTHORNE BLVD STE 230
TORRANCE CA
90503-1517
US

IV. Provider business mailing address

19000 HAWTHORNE BLVD #230
TORRANCE CA
90503-1517
US

V. Phone/Fax

Practice location:
  • Phone: 310-371-5151
  • Fax:
Mailing address:
  • Phone: 310-371-5151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT 2742
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225XE1200X
TaxonomyErgonomics Occupational Therapist
License NumberOT 2742
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License NumberOT 2742
License Number StateCA

VIII. Authorized Official

Name: MR. JONATHAN RIDDICK
Title or Position: OWNER/DIRECTOR
Credential: OTR/L, CHT
Phone: 310-371-5151