MEDICARE: COLMAN STEVENSON THERAPIES

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	252Y00000X	Early Intervention Provider Agency	CPH0002	CA

General Provider Information

NPI Number	:	1710286562
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLMAN STEVENSON THERAPIES

Provider Business Mailing Address
First Line	:	12062 VALLEY VIEW ST
Second Line	:	SUITE 137
City	:	GARDEN GROVE
State	:	CA
Zip	:	92845-1737
Country	:	US
Telephone Number	:	714-496-2299
Fax Number	:	866-274-0162

Provider Business Practice Location Address
First Line	:	4432 FIR AVE
Second Line	:
City	:	SEAL BEACH
State	:	CA
Zip	:	90740-2906
Country	:	US
Telephone Number	:	714-496-2299
Fax Number	:	866-274-0162

Authorized Official
Title or Position	:	OCCUPATIONAL THERAPIST
Name	:	MRS. CRYSTAL STEVENSON
Credential	:	OTR/L
Telephone Number	:	714-496-2299

Provider Enumeration Date	:	03/19/2011
Last Update Date	:	03/19/2011

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