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NPI Code Detail

MEDICARE: MR. JAMES WADE STREAM OTR/L

MEDICARE: MR. JAMES WADE STREAM OTR/L
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
1225X00000XOccupational TherapistOT 8240CA

General Provider Information

NPI Number : 1417114273
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JAMES WADE STREAM OTR/L
Provider Business Mailing Address
First Line : 1727 W GLENOAKS AVE APT 110
Second Line :
City : ANAHEIM
State : CA
Zip : 92801-4005
Country : US
Telephone Number : 714-262-3861
Fax Number :
Provider Business Practice Location Address
First Line : 2222 N HARBOR BLVD
Second Line :
City : FULLERTON
State : CA
Zip : 92835-2605
Country : US
Telephone Number : 714-333-1555
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/20/2008
Last Update Date : 05/20/2008

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Directions to “ MR. JAMES WADE STREAM OTR/L” Practice Location

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