Provider Demographics
NPI:1982575510
Name:ACORN ROOTS PEDIATRIC COLLECTIVE
Entity type:Organization
Organization Name:ACORN ROOTS PEDIATRIC COLLECTIVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:BRIANA
Authorized Official - Middle Name:RENE
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:818-470-8990
Mailing Address - Street 1:11940 LAURELWOOD DR APT 7
Mailing Address - Street 2:
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604-3755
Mailing Address - Country:US
Mailing Address - Phone:818-470-8990
Mailing Address - Fax:
Practice Address - Street 1:11940 LAURELWOOD DR APT 7
Practice Address - Street 2:
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91604-3755
Practice Address - Country:US
Practice Address - Phone:818-470-8990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-16
Last Update Date:2025-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty