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General NPI Number Information
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NPI Number | 1003365677
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Entity Type | Organization
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Legal Business Name | DASH AHEAD THERAPY
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Dates
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Enumeration Date | 09/23/2016
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Last Update Date | 09/23/2016
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Provider Practice Location Address
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Address Line | 40231 HACIENDA CT
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City | FREMONT
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State | CA
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Zip | 94539-3607
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Country | US
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Telephone | 510-497-4049
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Fax |
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Provider Business Mailing Address
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Address Line | 40231 HACIENDA CT
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City | FREMONT
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State | CA
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Zip | 94539-3607
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CO-OWNER
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Name | ANDREA SOUX HANCOCK
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Credential |
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Telephone | 510-497-4049
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | OT3300
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | OT6071
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License Number State | CA
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