MEDICARE: OCEANSIDE THERAPY GROUP, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SP17061	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1427186378	OTHER	CA	INDIVIDUAL NPI NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013246248
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OCEANSIDE THERAPY GROUP, INC.

Provider Business Mailing Address
First Line	:	1930 S COAST HWY
Second Line	:	103
City	:	OCEANSIDE
State	:	CA
Zip	:	92054-6455
Country	:	US
Telephone Number	:	760-529-4975
Fax Number	:	760-529-4761

Provider Business Practice Location Address
First Line	:	1930 S COAST HWY
Second Line	:	103
City	:	OCEANSIDE
State	:	CA
Zip	:	92054-6455
Country	:	US
Telephone Number	:	760-529-4975
Fax Number	:	760-529-4761

Authorized Official
Title or Position	:	OWNER/SPEECH-LANGUAGE PATHOLOGIST
Name	:	MRS. REBEKAH LOUISE VAN ORDEN
Credential	:	M.S., CCC-SLP
Telephone Number	:	760-529-4975

Provider Enumeration Date	:	12/17/2009
Last Update Date	:	12/17/2009

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Directions to “OCEANSIDE THERAPY GROUP, INC. ” Practice Location

Language	Start Address	Practice Location

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