MEDICARE: PEDIATRIC THERAPY NETWORK

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	251B00000X	Case Management Agency	8419	CA

General Provider Information

NPI Number	:	1639312929
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEDIATRIC THERAPY NETWORK

Provider Business Mailing Address
First Line	:	1815 W 213TH ST
Second Line	:
City	:	TORRANCE
State	:	CA
Zip	:	90501-2800
Country	:	US
Telephone Number	:	310-328-0276
Fax Number	:

Provider Business Practice Location Address
First Line	:	1815 W 213TH ST
Second Line	:	100
City	:	TORRANCE
State	:	CA
Zip	:	90501-2800
Country	:	US
Telephone Number	:	310-328-0276
Fax Number	:

Authorized Official
Title or Position	:	PEDIATRIC OCCUPATIONAL THERAPIST
Name	:	ANN L THATCHER
Credential	:	MOT
Telephone Number	:	310-328-0276

Provider Enumeration Date	:	04/16/2009
Last Update Date	:	04/16/2009

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