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General NPI Number Information
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NPI Number | 1588942882
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Entity Type | Organization
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Legal Business Name | STAFFREHAB
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Dates
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Enumeration Date | 08/03/2011
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Last Update Date | 08/03/2011
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Provider Practice Location Address
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Address Line | 5000 BIRCH ST 3000 WEST TOWER
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-2127
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Country | US
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Telephone | 188-883-5089
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Fax |
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Provider Business Mailing Address
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Address Line | 5000 BIRCH ST 3000 WEST TOWER
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-2127
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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 | OCCUPATIONAL THERAPIST
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Name | LATASHA LYNN-DIONYSIUS LARSON
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Credential | OTR/L
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Telephone | 320-293-3205
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 103693
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License Number State | MN
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