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General NPI Number Information
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NPI Number | 1427424175
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Entity Type | Organization
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Legal Business Name | SPROUT CHILDREN'S THERAPY CENTER, P.C.
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Dates
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Enumeration Date | 08/18/2015
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Last Update Date | 08/18/2015
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Provider Practice Location Address
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Address Line | 11332 CAMARILLO ST
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City | NORTH HOLLYWOOD
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State | CA
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Zip | 91602-1217
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Country | US
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Telephone | 310-918-3733
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Fax |
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Provider Business Mailing Address
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Address Line | 5150 AVENIDA HACIENDA
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City | TARZANA
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State | CA
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Zip | 91356-4225
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Country | US
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Telephone | 310-918-3733
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DANIELLE LEON
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Credential | OTR/L
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Telephone | 310-918-3733
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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 | 7242
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License Number State | CA
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