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General NPI Number Information
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NPI Number | 1285920983
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Entity Type | Organization
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Legal Business Name | SUPPLEMENTAL HEALTH CARE
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Dates
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Enumeration Date | 06/22/2011
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Last Update Date | 06/22/2011
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Provider Practice Location Address
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Address Line | 8425 KILTIE WY
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City | STOCKTON
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State | CA
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Zip | 95210
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Country | US
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Telephone | 209-467-6355
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Fax |
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Provider Business Mailing Address
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Address Line | 8425 KILTIE WAY
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City | STOCKTON
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State | CA
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Zip | 95210-2342
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Country | US
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Telephone | 209-467-6355
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Fax |
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Authorized Official
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Title or Position | OCCUPATIONAL THERAPIST
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Name | CHERYL SPAULDING
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Credential | OT
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Telephone | 209-467-6355
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | 2371
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License Number State | CA
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