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General NPI Number Information
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NPI Number | 1235330879
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Entity Type | Organization
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Legal Business Name | EDGEMOOR HOSPITAL
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Dates
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Enumeration Date | 05/30/2007
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Last Update Date | 09/19/2007
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Provider Practice Location Address
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Address Line | 9065 EDGEMOOR DR
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City | SANTEE
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State | CA
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Zip | 92071-3037
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Country | US
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Telephone | 619-956-2834
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Fax | 619-956-2914
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Provider Business Mailing Address
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Address Line | 10133 CAREFREE DR
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City | SANTEE
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State | CA
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Zip | 92071-1807
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Country | US
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Telephone | 619-328-6521
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Fax |
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Authorized Official
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Title or Position | OTR
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Name | BARBARA BROWN
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Credential |
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Telephone | 619-956-2834
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | OTA 781
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License Number State | CA
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