Provider Demographics
NPI:1154698819
Name:LAS CRUCES HAND THERAPY
Entity type:Organization
Organization Name:LAS CRUCES HAND THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:STOLIKER
Authorized Official - Suffix:
Authorized Official - Credentials:OTR CHT
Authorized Official - Phone:805-647-8800
Mailing Address - Street 1:8941 SANTA MARGARITA RD
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93004-3003
Mailing Address - Country:US
Mailing Address - Phone:805-794-1849
Mailing Address - Fax:805-647-8808
Practice Address - Street 1:970 PETIT AVE
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93004-2215
Practice Address - Country:US
Practice Address - Phone:805-647-8800
Practice Address - Fax:805-647-8808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-23
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT2135225XH1200X
CAOT5460225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHandGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0722410001Medicare NSC
CA056871Medicare PIN
CA056871Medicare Oscar/Certification