Healthcare Provider Details

I. General information

NPI: 1790029312
Provider Name (Legal Business Name): EDUCATIONAL THERAPY ASSESSMENT & SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2012
Last Update Date: 11/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34590 COUNTY LINE RD SUITE 7
YUCAIPA CA
92399-5303
US

IV. Provider business mailing address

34590 COUNTY LINE RD SUITE 7
YUCAIPA CA
92399-5303
US

V. Phone/Fax

Practice location:
  • Phone: 909-795-4255
  • Fax: 909-795-4438
Mailing address:
  • Phone: 909-795-4255
  • Fax: 909-795-4438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT10699
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code225XF0002X
TaxonomyFeeding, Eating & Swallowing Occupational Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: MS. DOREEN ANN SPEARMAN
Title or Position: PRESIDENT/EXECUTIVE DIRECTOR
Credential: PT
Phone: 909-795-4255