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General NPI Number Information
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NPI Number | 1487543104
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Entity Type | Organization
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Legal Business Name | PACIFIC KIDS OCCUPATIONAL THERAPY, PC
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Dates
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Enumeration Date | 06/30/2025
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Last Update Date | 06/30/2025
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Provider Practice Location Address
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Address Line | 33912 VIOLET LANTERN ST APT B
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City | DANA POINT
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State | CA
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Zip | 92629-5366
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Country | US
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Telephone | 608-279-1491
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 276
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City | DANA POINT
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State | CA
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Zip | 92629-0276
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Country | US
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Telephone | 608-279-1491
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. ALISA TAYLOR
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Credential | OTR/L
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Telephone | 608-279-1491
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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 |
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License Number State |
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