Provider Demographics
NPI:1639181811
Name:STOCKTON HAND THERAPY & REHABILITATION
Entity Type:Organization
Organization Name:STOCKTON HAND THERAPY & REHABILITATION
Other - Org Name:STOCKTON HAND THERAPY
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIANNE
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:CABALLERO-RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:OT/L, CHT
Authorized Official - Phone:209-956-8737
Mailing Address - Street 1:7824 SOUTHWORTH RD
Mailing Address - Street 2:
Mailing Address - City:VALLEY SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:95252-8971
Mailing Address - Country:US
Mailing Address - Phone:209-956-8737
Mailing Address - Fax:209-956-2586
Practice Address - Street 1:1919 GRAND CANAL BLVD
Practice Address - Street 2:SUITE C4
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-8114
Practice Address - Country:US
Practice Address - Phone:209-956-8737
Practice Address - Fax:209-956-2586
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-13
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2470225000000X, 225X00000X, 225XH1200X, 225XN1300X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHandGroup - Single Specialty
No225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic FitterGroup - Single Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
No225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitationGroup - Single Specialty
No335E00000XSuppliersProsthetic/Orthotic SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1172170OtherFIRST HEALTH
CA171713600OtherDEPARTMENT OF LABOR
CA5530198OtherAETNA
CAP00066568OtherMEDICARE RAILROAD
CAZZZ07989ZOtherBLUE SHIELD GROUP
CA171713600OtherDEPARTMENT OF LABOR
CAP00066568OtherMEDICARE RAILROAD