Provider Demographics
NPI:1932728367
Name:ADVANCE OCCUPATIONAL & HAND THERAPY CENTER
Entity Type:Organization
Organization Name:ADVANCE OCCUPATIONAL & HAND THERAPY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROSS
Authorized Official - Middle Name:
Authorized Official - Last Name:REZAEI
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L, HTC
Authorized Official - Phone:949-727-2192
Mailing Address - Street 1:22 ODYSSEY STE 165
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-3194
Mailing Address - Country:US
Mailing Address - Phone:949-727-2192
Mailing Address - Fax:949-727-2193
Practice Address - Street 1:401 N BROOKHURST ST STE 100
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-5614
Practice Address - Country:US
Practice Address - Phone:949-727-2192
Practice Address - Fax:949-727-2193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-15
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHandGroup - Multi-Specialty
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1093746752Medicaid