Provider Demographics
NPI:1487543104
Name:PACIFIC KIDS OCCUPATIONAL THERAPY, PC
Entity type:Organization
Organization Name:PACIFIC KIDS OCCUPATIONAL THERAPY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ALISA
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:608-279-1491
Mailing Address - Street 1:PO BOX 276
Mailing Address - Street 2:
Mailing Address - City:DANA POINT
Mailing Address - State:CA
Mailing Address - Zip Code:92629-0276
Mailing Address - Country:US
Mailing Address - Phone:608-279-1491
Mailing Address - Fax:
Practice Address - Street 1:33912 VIOLET LANTERN ST APT B
Practice Address - Street 2:
Practice Address - City:DANA POINT
Practice Address - State:CA
Practice Address - Zip Code:92629-5366
Practice Address - Country:US
Practice Address - Phone:608-279-1491
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-30
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty