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General NPI Number Information
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NPI Number | 1104653559
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Entity Type | Individual
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Provider Name | ALICE H FERGUSON OT
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Gender | Female
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Dates
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Enumeration Date | 09/18/2024
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Last Update Date | 09/18/2024
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Provider Practice Location Address
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Address Line | 1323 W COLTON AVE STE 105
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City | REDLANDS
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State | CA
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Zip | 92374-2853
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Country | US
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Telephone | 909-978-7997
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 10016
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City | REDLANDS
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State | CA
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Zip | 92375-3216
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Country | US
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Telephone | 909-883-5069
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 17481
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License Number State | CA
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