Organization
CARRICO PEDIATRIC THERAPY, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAN CARRICO M.A., OTR/L (OCCUPATIONAL THERAPIST)
(562) 607-1937
Entity
Organization
Contact information
Practice address
1301 W ARROW HWY, SUITE 130, SAN DIMAS, CA 91773-2330
(909) 599-8084
(909) 929-0805
Mailing address
1301 W ARROW HWY, SUITE 130, SAN DIMAS, CA 91773-2330
(909) 599-8084
(909) 929-0805
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
11906
CA
261QP2000X
Physical Therapy Clinic/Center
Primary
11906
CA
Other
Enumeration date
04/01/2016
Last updated
04/01/2016
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