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General NPI Number Information
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NPI Number | 1386094779
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Entity Type | Organization
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Legal Business Name | ARCTIC CIRCLE OCCUPATIONAL THERAPY
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Dates
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Enumeration Date | 06/15/2016
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Last Update Date | 06/15/2016
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Provider Practice Location Address
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Address Line | 1224 10TH ST STE 201
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City | CORONADO
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State | CA
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Zip | 92118-3420
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Country | US
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Telephone | 619-537-6117
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Fax |
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Provider Business Mailing Address
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Address Line | 1224 10TH ST STE 201
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City | CORONADO
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State | CA
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Zip | 92118-3420
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CLINIC DIRECTOR
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Name | DR. TARA-RENEE WHALEN
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Credential | OTD, OTR/L
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Telephone | 619-537-6117
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | 11769
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License Number State | CA
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