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Organization
TUSTIN SPEECH THERAPY, INC
Active
Organization
TUSTIN SPEECH THERAPY, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KYMRY HART FOWLER MS-CCC (CHIEF EXECUTIVE OFFICER)
(714) 838-2853
Entity
Organization
Contact information
Practice address
661 W 1ST ST STE E, TUSTIN, CA 92780-2939
(714) 838-2853
Mailing address
661 W 1ST ST STE E, TUSTIN, CA 92780-2939
(714) 838-2853
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
2634
CA
225X00000X
Occupational Therapist
722
CA
225XP0200X
Pediatric Occupational Therapist
722
CA
2355S0801X
Speech-Language Assistant
655
CA
235Z00000X
Speech-Language Pathologist
Primary
17425
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0050430
—
CA
Enumeration date
05/09/2014
Last updated
05/09/2014
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