MEDICARE: ADVANCE OCCUPATIONAL & HAND THERAPY CENTER

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	2251X0800X	Orthopedic Physical Therapist
2	225XH1200X	Hand Occupational Therapist

General Provider Information

NPI Number	:	1538788054
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCE OCCUPATIONAL & HAND THERAPY CENTER

Provider Business Mailing Address
First Line	:	22 ODYSSEY STE 165
Second Line	:
City	:	IRVINE
State	:	CA
Zip	:	92618-3194
Country	:	US
Telephone Number	:	949-727-2192
Fax Number	:	949-727-2193

Provider Business Practice Location Address
First Line	:	1520 BROOKHOLLOW DR STE 37
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92705-5427
Country	:	US
Telephone Number	:	714-953-7330
Fax Number	:	949-727-2193

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. ROSS REZAEI
Credential	:	OTR/L,HTC
Telephone Number	:	949-727-2192

Provider Enumeration Date	:	04/14/2020
Last Update Date	:	06/21/2021

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