MEDICARE: MISS SANDRA GAIL RUTSTEIN OTR,L

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	225XP0200X	Pediatric Occupational Therapist	OT4777	CA

General Provider Information

NPI Number	:	1922295401
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS SANDRA GAIL RUTSTEIN OTR,L

Provider Business Mailing Address
First Line	:	191 S OAK PARK BLVD STE 9
Second Line	:
City	:	GROVER BEACH
State	:	CA
Zip	:	93433-2265
Country	:	US
Telephone Number	:	805-474-6811
Fax Number	:	805-668-2290

Provider Business Practice Location Address
First Line	:	191 S OAK PARK BLVD STE 9
Second Line	:
City	:	GROVER BEACH
State	:	CA
Zip	:	93433-2265
Country	:	US
Telephone Number	:	805-474-6811
Fax Number	:	805-668-2290

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/28/2007
Last Update Date	:	02/21/2024

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