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General NPI Number Information
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NPI Number | 1205608924
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Entity Type | Organization
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Legal Business Name | OCEANS THERAPY & SPEECH PATHOLOGY, INC.
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Dates
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Enumeration Date | 10/25/2023
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Last Update Date | 03/14/2024
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Provider Practice Location Address
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Address Line | 3420 BRISTOL ST FL 6
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City | COSTA MESA
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State | CA
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Zip | 92626-7170
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Country | US
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Telephone | 714-794-2034
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Fax |
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Provider Business Mailing Address
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Address Line | 412 OLIVE AVE # 177
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92648-5142
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Country | US
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Telephone | 714-951-1534
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | CASSANDRA RANDOLPH
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Credential | M.S., CCC-SLP
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Telephone | 714-951-1534
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0700X
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Taxonomy Name | Hearing and Speech Clinic/Center
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License Number |
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License Number State |
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