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  7. NPI Record 1639181811

STOCKTON HAND THERAPY
Complete NPI Record 1639181811
Occupational Therapist - Hand in Stockton, CA

NPI Status: Active since August 13, 2006

Contact Information

1919 GRAND CANAL BLVD
SUITE C4
STOCKTON, CA
ZIP 95207
Phone: (209) 956-8737
Fax: (209) 956-2586

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Table of Contents

  1. NPI
  2. Entity Type Code
  3. Employer Identification Number EIN
  4. Provider Organization Name Legal Business Name
  5. Provider Other Organization Name
  6. Provider Other Organization Name Type Code
  7. Provider First Line Business Mailing Address
  8. Provider Business Mailing Address City Name
  9. Provider Business Mailing Address State Name
  10. Provider Business Mailing Address Postal Code
  11. Provider Business Mailing Address Country Code If outside U S
  12. Provider Business Mailing Address Telephone Number
  13. Provider Business Mailing Address Fax Number
  14. Provider First Line Business Practice Location Address
  15. Provider Second Line Business Practice Location Address
  16. Provider Business Practice Location Address City Name
  17. Provider Business Practice Location Address State Name
  18. Provider Business Practice Location Address Postal Code
  19. Provider Business Practice Location Address Country Code If outside U S
  20. Provider Business Practice Location Address Telephone Number
  21. Provider Business Practice Location Address Fax Number
  22. Provider Enumeration Date
  23. Last Update Date
  24. Authorized Official Last Name
  25. Authorized Official First Name
  26. Authorized Official Middle Name
  27. Authorized Official Title or Position
  28. Authorized Official Telephone Number
  29. Healthcare Provider Taxonomy Code 1
  30. Provider License Number 1
  31. Provider License Number State Code 1
  32. Healthcare Provider Primary Taxonomy Switch 1
  33. Healthcare Provider Taxonomy Code 2
  34. Provider License Number 2
  35. Provider License Number State Code 2
  36. Healthcare Provider Primary Taxonomy Switch 2
  37. Healthcare Provider Taxonomy Code 3
  38. Provider License Number 3
  39. Provider License Number State Code 3
  40. Healthcare Provider Primary Taxonomy Switch 3
  41. Healthcare Provider Taxonomy Code 4
  42. Provider License Number 4
  43. Provider License Number State Code 4
  44. Healthcare Provider Primary Taxonomy Switch 4
  45. Healthcare Provider Taxonomy Code 5
  46. Provider License Number 5
  47. Provider License Number State Code 5
  48. Healthcare Provider Primary Taxonomy Switch 5
  49. Other Provider Identifier 1
  50. Other Provider Identifier Type Code 1
  51. Other Provider Identifier State 1
  52. Other Provider Identifier Issuer 1
  53. Other Provider Identifier 2
  54. Other Provider Identifier Type Code 2
  55. Other Provider Identifier State 2
  56. Other Provider Identifier Issuer 2
  57. Other Provider Identifier 3
  58. Other Provider Identifier Type Code 3
  59. Other Provider Identifier State 3
  60. Other Provider Identifier Issuer 3
  61. Other Provider Identifier 4
  62. Other Provider Identifier Type Code 4
  63. Other Provider Identifier State 4
  64. Other Provider Identifier Issuer 4
  65. Other Provider Identifier 5
  66. Other Provider Identifier Type Code 5
  67. Other Provider Identifier State 5
  68. Other Provider Identifier Issuer 5
  69. Is Organization Subpart
  70. Authorized Official Name Prefix Text
  71. Authorized Official Credential Text
  72. Healthcare Provider Taxonomy Group 1
  73. Healthcare Provider Taxonomy Group 2
  74. Healthcare Provider Taxonomy Group 3
  75. Healthcare Provider Taxonomy Group 5

Complete NPI Dataset

This page represents the complete record for NPI 1639181811. You can access the complete dataset, including a full list of field names, along with their values, and definitions as recorded by the NPI registry. Each field in the NPI record is explained, highlighting its significance and the possible values it can hold.

NPI: 1639181811
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
Entity Type Code: 2
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Employer Identification Number EIN: UNAVAIL
The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
The name of the organization provider. If the provider is an organization, this is the legal business name.
Provider Other Organization Name: STOCKTON HAND THERAPY
Other name by which the organization provider is or has been known.
Provider Other Organization Name Type Code: 5
Code identifying the type of other name. Codes are: 1 = former name; 2 = professional name; 3 = doing business as (d/b/ a) name; 4 = former legal business name; 5 = other.
Provider First Line Business Mailing Address: 7824 SOUTHWORTH RD
The first line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider first line location address’’.
Provider Business Mailing Address City Name: VALLEY SPRINGS
The city name in the mailing address of the provider being identified.
Provider Business Mailing Address State Name: CA
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’.
Provider Business Mailing Address Postal Code: 952528971
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Provider Business Mailing Address Country Code If outside U S : US
The country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Provider Business Mailing Address Telephone Number: 2099568737
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address telephone number’’.
Provider Business Mailing Address Fax Number: 2099562586
The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address fax number’’.
Provider First Line Business Practice Location Address: 1919 GRAND CANAL BLVD
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Second Line Business Practice Location Address: SUITE C4
The second line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City Name: STOCKTON
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State Name: CA
The State code in the location of the provider being identified.
Provider Business Practice Location Address Postal Code: 952078114
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Country Code If outside U S : US
The country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number: 2099568737
The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number: 2099562586
The fax number associated with the location address of the provider being identified.
Provider Enumeration Date: 8/13/2006
The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date: 9/23/2009
The date that a record was last updated or changed.
Authorized Official Last Name: CABALLERO-RODRIGUEZ
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
Authorized Official First Name: MARIANNE
The first name of the authorized official.
Authorized Official Middle Name: RENEE
The middle name of the authorized official.
Authorized Official Title or Position: PRESIDENT
The title or position of the authorized official.
Authorized Official Telephone Number: 2099568737
The 10-position telephone number of the authorized official.
Healthcare Provider Taxonomy Code 1: 225000000X
Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Provider License Number 1: 2470
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 1: CA
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 1: N
Healthcare Provider Taxonomy Code 2: 225X00000X
Provider License Number 2: 2470
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 2: CA
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 2: N
Healthcare Provider Taxonomy Code 3: 225XN1300X
Provider License Number 3: 2470
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 3: CA
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 3: N
Healthcare Provider Taxonomy Code 4: 335E00000X
Provider License Number 4: 2470
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 4: CA
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 4: N
Healthcare Provider Taxonomy Code 5: 225XH1200X
Provider License Number 5: 2470
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 5: CA
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 5: Y
Other Provider Identifier 1: ZZZ07989Z
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 1: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 1: CA
Other Provider Identifier Issuer 1: BLUE SHIELD GROUP
Other Provider Identifier 2: 1172170
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 2: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 2: CA
Other Provider Identifier Issuer 2: FIRST HEALTH
Other Provider Identifier 3: 5530198
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 3: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 3: CA
Other Provider Identifier Issuer 3: AETNA
Other Provider Identifier 4: 171713600
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 4: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 4: CA
Other Provider Identifier Issuer 4: DEPARTMENT OF LABOR
Other Provider Identifier 5: P00066568
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 5: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 5: CA
Other Provider Identifier Issuer 5: MEDICARE RAILROAD
Is Organization Subpart: N
Authorized Official Name Prefix Text: MS.
Authorized Official Credential Text: OT/L, CHT
Healthcare Provider Taxonomy Group 1: 193400000X MULTIPLE SINGLE SPECIALTY GROUP
Healthcare Provider Taxonomy Group 2: 193400000X MULTIPLE SINGLE SPECIALTY GROUP
Healthcare Provider Taxonomy Group 3: 193400000X MULTIPLE SINGLE SPECIALTY GROUP
Healthcare Provider Taxonomy Group 5: 193400000X MULTIPLE SINGLE SPECIALTY GROUP