MEDICARE: MS. COLEEN SONGCUYA OTR

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	225X00000X	Occupational Therapist	5582	CA

General Provider Information

NPI Number	:	1972950111
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. COLEEN SONGCUYA OTR

Provider Business Mailing Address
First Line	:	1066 S GRAND AVENUE, #E22
Second Line	:
City	:	DIAMOND BAR
State	:	CA
Zip	:	91765
Country	:	US
Telephone Number	:	909-802-8883
Fax Number	:

Provider Business Practice Location Address
First Line	:	1066 S GRAND AVENUE, #E22
Second Line	:
City	:	DIAMOND BAR
State	:	CA
Zip	:	91765
Country	:	US
Telephone Number	:	909-802-8883
Fax Number	:

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

Provider Enumeration Date	:	05/18/2016
Last Update Date	:	05/18/2016

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