Provider Demographics
NPI:1336248715
Name:VANHONSEBROUCK, BARON (OT,CHT)
Entity Type:Individual
Prefix:
First Name:BARON
Middle Name:
Last Name:VANHONSEBROUCK
Suffix:
Gender:M
Credentials:OT,CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11335A FOLSOM BLVD
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95742-6224
Mailing Address - Country:US
Mailing Address - Phone:916-858-0950
Mailing Address - Fax:916-858-0972
Practice Address - Street 1:11335A FOLSOM BLVD
Practice Address - Street 2:
Practice Address - City:RANCHO CORDOVA
Practice Address - State:CA
Practice Address - Zip Code:95742-6224
Practice Address - Country:US
Practice Address - Phone:916-858-0950
Practice Address - Fax:916-858-0972
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT2217225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ27019ZMedicare ID - Type Unspecified