Provider Demographics
NPI:1093746752
Name:ADVANCE OCCUPATIONAL & HAND THERAPY CENTER
Entity Type:Organization
Organization Name:ADVANCE OCCUPATIONAL & HAND THERAPY CENTER
Other - Org Name:SEVEN TO 7 PHYSICAL & HAND THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROSS
Authorized Official - Middle Name:
Authorized Official - Last Name:REZAEI
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L, HTC
Authorized Official - Phone:949-727-2192
Mailing Address - Street 1:22 ODYSSEY
Mailing Address - Street 2:SUITE #: 165
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-3186
Mailing Address - Country:US
Mailing Address - Phone:949-727-2192
Mailing Address - Fax:949-727-2193
Practice Address - Street 1:22 ODYSSEY STE 165
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3194
Practice Address - Country:US
Practice Address - Phone:949-285-3098
Practice Address - Fax:949-727-2193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT38428225100000X
CAPT33635225100000X
CAOT1251225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHandGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA3791439Medicaid
CAOT0012510OtherBLUE SHIELD
CAZZZ64792ZOtherBLUE SHIELD
CAOT0012510OtherBLUE SHIELD
CA3791439Medicaid