MEDICARE: THE LEARNING FOUNTAIN, INC.

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	225XF0002X	Feeding, Eating & Swallowing Occupational Therapist	OT 401	CA
2	225X00000X	Occupational Therapist	OT401	CA
3	235Z00000X	Speech-Language Pathologist	SP 15247	CA
4	2251P0200X	Pediatric Physical Therapist	PT8071	CA
5	225100000X	Physical Therapist	PT8071	CA
6	225XP0200X	Pediatric Occupational Therapist	OT 401	CA

General Provider Information

NPI Number	:	1669606182
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE LEARNING FOUNTAIN, INC.

Provider Business Mailing Address
First Line	:	2819 CROW CANYON RD
Second Line	:	# 205
City	:	SAN RAMON
State	:	CA
Zip	:	94583-1655
Country	:	US
Telephone Number	:	925-264-9810
Fax Number	:	925-263-1906

Provider Business Practice Location Address
First Line	:	2819 CROW CANYON RD
Second Line	:	SUITE 205
City	:	SAN RAMON
State	:	CA
Zip	:	94583-1655
Country	:	US
Telephone Number	:	925-264-9810
Fax Number	:	925-263-1906

Authorized Official
Title or Position	:	PRESIDENT
Name	:	EUFROCINA SALONGA
Credential	:	OTR/L, SWC
Telephone Number	:	925-264-9810

Provider Enumeration Date	:	05/12/2009
Last Update Date	:	07/03/2013

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Directions to “THE LEARNING FOUNTAIN, INC. ” Practice Location

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