Healthcare Provider Details

I. General information

NPI: 1114250040
Provider Name (Legal Business Name): OCCUPATIONAL AND HAND THERAPY CTR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2009
Last Update Date: 09/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1406 CRENSHAW BLVD
TORRANCE CA
90501
US

IV. Provider business mailing address

1406 CRENSHAW BLVD
TORRANCE CA
90501
US

V. Phone/Fax

Practice location:
  • Phone: 310-328-7377
  • Fax: 310-328-8319
Mailing address:
  • Phone: 310-328-7377
  • Fax: 310-328-8319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberBUS-0106005
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License NumberBUS-0106005
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License NumberBUS-0106005
License Number StateCA

VIII. Authorized Official

Name: JACQUELINE SCHAEFFER
Title or Position: ACCOUNT MGR
Credential:
Phone: 310-328-7377