Provider Demographics
NPI:1790029312
Name:EDUCATIONAL THERAPY ASSESSMENT & SERVICES
Entity Type:Organization
Organization Name:EDUCATIONAL THERAPY ASSESSMENT & SERVICES
Other - Org Name:ETAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DOREEN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SPEARMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:909-795-4255
Mailing Address - Street 1:34590 COUNTY LINE RD
Mailing Address - Street 2:SUITE 7
Mailing Address - City:YUCAIPA
Mailing Address - State:CA
Mailing Address - Zip Code:92399-5303
Mailing Address - Country:US
Mailing Address - Phone:909-795-4255
Mailing Address - Fax:909-795-4438
Practice Address - Street 1:34590 COUNTY LINE RD
Practice Address - Street 2:SUITE 7
Practice Address - City:YUCAIPA
Practice Address - State:CA
Practice Address - Zip Code:92399-5303
Practice Address - Country:US
Practice Address - Phone:909-795-4255
Practice Address - Fax:909-795-4438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-20
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2251P0200X, 225XF0002X, 235Z00000X, 261QD1600X
CAPT10699261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty
No225XF0002XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistFeeding, Eating & SwallowingGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Multi-Specialty