Provider Demographics
NPI:1962560359
Name:EL CERRITO HAND THERAPY & ACUPUNCTURE REHAB. INC
Entity type:Organization
Organization Name:EL CERRITO HAND THERAPY & ACUPUNCTURE REHAB. INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER OT
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:CUPPLES
Authorized Official - Suffix:
Authorized Official - Credentials:OTR CHT LAC
Authorized Official - Phone:510-525-2700
Mailing Address - Street 1:6328 FAIRMOUNT AVENUE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:EL CERRITO
Mailing Address - State:CA
Mailing Address - Zip Code:94530
Mailing Address - Country:US
Mailing Address - Phone:510-525-2700
Mailing Address - Fax:510-525-2716
Practice Address - Street 1:6328 FAIRMOUNT AVENUE
Practice Address - Street 2:SUITE 220
Practice Address - City:EL CERRITO
Practice Address - State:CA
Practice Address - Zip Code:94530
Practice Address - Country:US
Practice Address - Phone:510-525-2700
Practice Address - Fax:510-525-2716
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7709171100000X
CA8741171100000X
225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHandGroup - Single Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ64665ZOtherANTHEM BLUE CROSS
CA7458150001Medicare NSC