Organization
SHATTUCK REHABILITATION SERVICES
Active
Other names
Healing Hands Therapy & Wellness Center
Organization subpart
No
Provider details
NPI number
Authorized official
JEANETTE LOUISE SHATTUCK OTR L (PRESIDENT)
(562) 430-8700
Entity
Organization
Contact information
Practice address
4772 KATELLA AVE STE 100, LOS ALAMITOS, CA 90720-2681
(562) 430-8700
(562) 430-8760
Mailing address
4772 KATELLA AVE STE 100, LOS ALAMITOS, CA 90720-2681
(562) 430-8700
(562) 430-8760
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
AA358119
CA
225XE1200X
Ergonomics Occupational Therapist
AA358119
CA
225XH1200X
Hand Occupational Therapist
Primary
AA358119
CA
335E00000X
Prosthetic/Orthotic Supplier
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
08127ADOC
ADOC ID
CA
01
—
205696000
DEPT OF LABOR ACS
CA
01
—
ZZZ07888Z
BLUE SHIELD GROUP
CA
Enumeration date
03/08/2007
Last updated
02/19/2015
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