Provider Demographics
NPI:1144618232
Name:REDFERN, TODD
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:
Last Name:REDFERN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25707 HOLIDAY CIRCLE UNIT A
Mailing Address - Street 2:
Mailing Address - City:STEVENSON RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:91381
Mailing Address - Country:US
Mailing Address - Phone:661-312-0788
Mailing Address - Fax:
Practice Address - Street 1:25707 HOLIDAY CIR APT A
Practice Address - Street 2:
Practice Address - City:STEVENSON RANCH
Practice Address - State:CA
Practice Address - Zip Code:91381-1270
Practice Address - Country:US
Practice Address - Phone:661-312-0788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-26
Last Update Date:2014-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1363225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist