Provider Demographics
NPI:1174912323
Name:HELLSTROM, THERESA
Entity type:Individual
Prefix:MS
First Name:THERESA
Middle Name:
Last Name:HELLSTROM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1760 WOODCREST AVE
Mailing Address - Street 2:
Mailing Address - City:LA HABRA
Mailing Address - State:CA
Mailing Address - Zip Code:90631-3261
Mailing Address - Country:US
Mailing Address - Phone:714-585-5202
Mailing Address - Fax:
Practice Address - Street 1:1760 WOODCREST AVE
Practice Address - Street 2:
Practice Address - City:LA HABRA
Practice Address - State:CA
Practice Address - Zip Code:90631-3261
Practice Address - Country:US
Practice Address - Phone:714-585-5202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-12
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13880225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist