Provider Demographics
NPI:1568538064
Name:CAPUCHINO THERAPY GROUP
Entity type:Organization
Organization Name:CAPUCHINO THERAPY GROUP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:LULA
Authorized Official - Middle Name:M
Authorized Official - Last Name:CAPUCHINO
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:916-481-1300
Mailing Address - Street 1:1015 RILEY STREET
Mailing Address - Street 2:#6268
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-6268
Mailing Address - Country:US
Mailing Address - Phone:916-481-1300
Mailing Address - Fax:916-365-9870
Practice Address - Street 1:3601 MARCONI AVE
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95821-5309
Practice Address - Country:US
Practice Address - Phone:916-481-1300
Practice Address - Fax:916-365-9870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT2084225000000X, 225XF0002X, 225XH1200X, 225XP0200X, 225XR0403X
CAPT231142251E1200X
CAPT400452251X0800X
CA2084225X00000X
CASP6954235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic FitterGroup - Multi-Specialty
No2251E1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistErgonomicsGroup - Multi-Specialty
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No225XF0002XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistFeeding, Eating & SwallowingGroup - Multi-Specialty
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHandGroup - Multi-Specialty
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
No225XR0403XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistDriving and Community MobilityGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA616046300OtherDEPT OF LABOR
CAZZZ53443YOtherBLUE SHIELD - PT
CAZZZ72016YOtherBLUE SHIELD - SP
CAZZZ67977ZOtherBLUE SHIELD - OT
CABA402Medicare PIN