Provider Demographics
NPI:1558624759
Name:SAN DIEGO OCCUPATIONAL THERAPI INC
Entity Type:Organization
Organization Name:SAN DIEGO OCCUPATIONAL THERAPI INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO SAN DIEGO OCCUPATIONAL THERAPY
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DRUMMOND
Authorized Official - Suffix:
Authorized Official - Credentials:OTD, OTR/L
Authorized Official - Phone:760-814-5096
Mailing Address - Street 1:12625 HIGH BLUFF DR STE 113
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-2053
Mailing Address - Country:US
Mailing Address - Phone:760-814-5096
Mailing Address - Fax:760-544-5120
Practice Address - Street 1:12625 HIGH BLUFF DR STE 113
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-2053
Practice Address - Country:US
Practice Address - Phone:760-814-5096
Practice Address - Fax:760-544-5120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-21
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1076225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty