Provider Demographics
NPI:1427502400
Name:MALIBU OCCUPATIONAL & SPEECH THERAPY
Entity type:Organization
Organization Name:MALIBU OCCUPATIONAL & SPEECH THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MA, OTR/L/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-456-0400
Mailing Address - Street 1:23823 MALIBU RD
Mailing Address - Street 2:STE 50 #242
Mailing Address - City:MALIBU
Mailing Address - State:CA
Mailing Address - Zip Code:90265-4628
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:22837 PACIFIC COAST HWY
Practice Address - Street 2:SUITE F
Practice Address - City:MALIBU
Practice Address - State:CA
Practice Address - Zip Code:90265-5837
Practice Address - Country:US
Practice Address - Phone:310-456-0400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-08
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT10208252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency