MEDICARE: LAS CRUCES HAND THERAPY

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	225XH1200X	Hand Occupational Therapist	OT2135	CA
2	225XH1200X	Hand Occupational Therapist	OT5460	CA

General Provider Information

NPI Number	:	1154698819
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAS CRUCES HAND THERAPY

Provider Business Mailing Address
First Line	:	8941 SANTA MARGARITA RD
Second Line	:
City	:	VENTURA
State	:	CA
Zip	:	93004-3003
Country	:	US
Telephone Number	:	805-794-1849
Fax Number	:	805-647-8808

Provider Business Practice Location Address
First Line	:	970 PETIT AVE
Second Line	:
City	:	VENTURA
State	:	CA
Zip	:	93004-2215
Country	:	US
Telephone Number	:	805-647-8800
Fax Number	:	805-647-8808

Authorized Official
Title or Position	:	OWNER
Name	:	MS. MARY STOLIKER
Credential	:	OTR CHT
Telephone Number	:	805-647-8800

Provider Enumeration Date	:	11/23/2011
Last Update Date	:	03/17/2014

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Directions to “LAS CRUCES HAND THERAPY ” Practice Location

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