Provider Demographics
NPI:1689673816
Name:REDWOOD HAND THERAPY INC
Entity Type:Organization
Organization Name:REDWOOD HAND THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:B
Authorized Official - Last Name:EAKIN
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L, CHT
Authorized Official - Phone:707-544-2637
Mailing Address - Street 1:320 TESCONI CIR
Mailing Address - Street 2:SUITE G
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95401-4611
Mailing Address - Country:US
Mailing Address - Phone:707-544-2637
Mailing Address - Fax:707-544-2088
Practice Address - Street 1:320 TESCONI CIR
Practice Address - Street 2:SUITE G
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-4611
Practice Address - Country:US
Practice Address - Phone:707-544-2637
Practice Address - Fax:707-544-2088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-19
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHandGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ00752ZOtherBLUE SHIELD OF CALIFORNIA
CADF7890OtherMEDICARE RAILROAD
CAZZZ04550ZMedicare PIN
CADF7890OtherMEDICARE RAILROAD