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General NPI Number Information
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NPI Number | 1437309077
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Entity Type | Organization
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Legal Business Name | BLUE DOVE REHABILITATION, INC.
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Dates
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Enumeration Date | 09/19/2008
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Last Update Date | 09/11/2019
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Provider Practice Location Address
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Address Line | 323 N PRAIRIE AVE STE 401
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City | INGLEWOOD
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State | CA
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Zip | 90301-4506
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Country | US
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Telephone | 310-412-2126
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Fax | 310-412-2077
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Provider Business Mailing Address
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Address Line | P.O. BOX 34925
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City | LOS ANGELES
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State | CA
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Zip | 90034
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Country | US
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Telephone | 310-412-2126
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Fax | 310-412-2077
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Authorized Official
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Title or Position | PRESIDENT/DIRECTOR
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Name | MRS. LAUREN F. KAWASAKI-KNIGHT
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Credential | M.A., CCC-SLP
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Telephone | 310-412-2126
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | SP13846
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SP13846
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License Number State | CA
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