MEDICARE: STOCKTON HAND THERAPY & REHABILITATION

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	225000000X	Orthotic Fitter	2470	CA
2	225X00000X	Occupational Therapist	2470	CA
3	225XN1300X	Neurorehabilitation Occupational Therapist	2470	CA
4	335E00000X	Prosthetic/Orthotic Supplier	2470	CA
5	225XH1200X	Hand Occupational Therapist	2470	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	P00066568	OTHER	CA	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1172170	OTHER	CA	FIRST HEALTH
2	171713600	OTHER	CA	DEPARTMENT OF LABOR
3	5530198	OTHER	CA	AETNA
5	ZZZ07989Z	OTHER	CA	BLUE SHIELD GROUP

General Provider Information

NPI Number	:	1639181811
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STOCKTON HAND THERAPY & REHABILITATION

Provider Business Mailing Address
First Line	:	7824 SOUTHWORTH RD
Second Line	:
City	:	VALLEY SPRINGS
State	:	CA
Zip	:	95252-8971
Country	:	US
Telephone Number	:	209-956-8737
Fax Number	:	209-956-2586

Provider Business Practice Location Address
First Line	:	1919 GRAND CANAL BLVD
Second Line	:	SUITE C4
City	:	STOCKTON
State	:	CA
Zip	:	95207-8114
Country	:	US
Telephone Number	:	209-956-8737
Fax Number	:	209-956-2586

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. MARIANNE RENEE CABALLERO-RODRIGUEZ
Credential	:	OT/L, CHT
Telephone Number	:	209-956-8737

Provider Enumeration Date	:	08/13/2006
Last Update Date	:	09/23/2009

Similar Medicare Providers

1659383925 — MS. MARIANNE RENEE CABALLERO-RODRIGUEZ OT/L, CHT
Practice Location Address:

1919 GRAND CANAL BLVD , SUITE C-4
STOCKTON, CA
95207-8114

Practice Phone: 209-956-8737
Practice Fax: 209-956-2586

1568686319 — MS. ALEXANDRA PEZZI CONGER LMFT
Practice Location Address:

1919 GRAND CANAL BLVD STE C3
STOCKTON, CA
95207-8114

Practice Phone: 209-601-2727
Practice Fax:

1073724498 — STOCKTON HAND THERAPY & REHABILITATION
Practice Location Address:

1919 GRAND CANAL BLVD , SUITE C4
STOCKTON, CA
95207-8114

Practice Phone: 209-956-8737
Practice Fax: 209-956-2586

1689711046 — LUXOTTICA OF AMERICA INC
Practice Location Address:

4000 LUXOTTICA PL , ATTN MEDICARE DEPT
MASON, OH
45040-8114

Practice Phone: 513-765-3534
Practice Fax:

1205389764 — LUXOTTICA RETAIL NORTH AMERICA INC
Practice Location Address:

4000 LUXOTTICA PL , ATTN: MEDICARE DEPT
MASON, OH
45040-8114

Practice Phone: 513-765-6000
Practice Fax:

1538603709 — LUXOTTICA RETAIL NORTH AMERICA INC.
Practice Location Address:

4000 LUXOTTICA PL , ATTN: MEDICARE DEPARTMENT
MASON, OH
45040-8114

Practice Phone: 513-765-6623
Practice Fax:

Directions to “STOCKTON HAND THERAPY & REHABILITATION ” Practice Location

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