=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003451931
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CENTRAL COAST HAND THERAPY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/14/2019
-----------------------------------------------------
Last Update Date | 12/16/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4 ROSSI CIR STE 151
-----------------------------------------------------
City | SALINAS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93907-2361
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 831-755-7755
-----------------------------------------------------
Fax | 831-755-7705
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4 ROSSI CIR STE 151
-----------------------------------------------------
City | SALINAS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93907-2361
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 831-755-7755
-----------------------------------------------------
Fax | 831-755-7705
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/OCCUPATIONAL THERAPIST
-----------------------------------------------------
Name | MS. TAMMY DENISE MODISETTE
-----------------------------------------------------
Credential | MS, OTR/L
-----------------------------------------------------
Telephone | 831-718-7368
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------