Provider Demographics
NPI:1760778393
Name:SM REHAB INC
Entity Type:Organization
Organization Name:SM REHAB INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MASHEILAPIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MANABAT
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:714-875-8051
Mailing Address - Street 1:2121 W CRESCENT AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-3810
Mailing Address - Country:US
Mailing Address - Phone:714-875-8051
Mailing Address - Fax:
Practice Address - Street 1:2121 W CRESCENT AVE
Practice Address - Street 2:SUITE C
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-3810
Practice Address - Country:US
Practice Address - Phone:714-875-8051
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-22
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT 10147225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty