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General NPI Number Information
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NPI Number | 1649574807
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Entity Type | Organization
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Legal Business Name | GOLD COUNTRY OCCUPATIONAL THERAPY
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Dates
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Enumeration Date | 01/03/2011
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Last Update Date | 01/21/2011
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Provider Practice Location Address
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Address Line | 252 N. MAIN STREET
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City | ANGELS CAMP
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State | CA
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Zip | 95222
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Country | US
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Telephone | 209-736-9589
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 278
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City | ANGELS CAMP
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State | CA
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Zip | 95222-0278
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Country | US
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Telephone | 209-743-7211
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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 | MS. SUSAN MARY LYNEIS-SIRIAS
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Credential | OTR
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Telephone | 209-736-9589
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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 | OT 681
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 225XE1200X
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Taxonomy Name | Ergonomics Occupational Therapist
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License Number | OT 681
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 225XF0002X
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Taxonomy Name | Feeding, Eating & Swallowing Occupational Therapist
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License Number | OT5244
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 225XG0600X
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Taxonomy Name | Gerontology Occupational Therapist
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License Number | OT 681
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License Number State | CA
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Taxonomy #5
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Taxonomy Code | 225XH1200X
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Taxonomy Name | Hand Occupational Therapist
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License Number | OT 681
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License Number State | CA
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Taxonomy #6
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Taxonomy Code | 225XN1300X
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Taxonomy Name | Neurorehabilitation Occupational Therapist
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License Number | OT5244
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License Number State | CA
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Taxonomy #7
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Taxonomy Code | 225XP0019X
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Taxonomy Name | Physical Rehabilitation Occupational Therapist
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License Number | OT5244
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License Number State | CA
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Taxonomy #8
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Taxonomy Code | 225XP0019X
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Taxonomy Name | Physical Rehabilitation Occupational Therapist
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License Number | OT 681
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License Number State | CA
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Taxonomy #9
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | OT5244
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License Number State | CA
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Taxonomy #10
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT5244
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License Number State | CA
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