Provider Demographics
NPI:1154647592
Name:OT SPECIALISTS
Entity Type:Organization
Organization Name:OT SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FAITH
Authorized Official - Middle Name:
Authorized Official - Last Name:REPKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-287-1723
Mailing Address - Street 1:5917 OAK AVE
Mailing Address - Street 2:PMB 121
Mailing Address - City:TEMPLE CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91780-2028
Mailing Address - Country:US
Mailing Address - Phone:626-287-1723
Mailing Address - Fax:626-791-4662
Practice Address - Street 1:5917 OAK AVE
Practice Address - Street 2:PMB 121
Practice Address - City:TEMPLE CITY
Practice Address - State:CA
Practice Address - Zip Code:91780-2028
Practice Address - Country:US
Practice Address - Phone:626-287-1723
Practice Address - Fax:626-791-4662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-09
Last Update Date:2010-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1888225XP0019X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty
No225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical RehabilitationGroup - Single Specialty