Individual provider Active NPI

Wendy Soesman, OTR/L

  • Pediatric Occupational Therapist
  • Brea, CA
National Provider Identifier
1740544311
Registry record updated Jul 26, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Occupational TherapistTaxonomy code 225XP0200X
License
2105 Issued in CA
Practice address
2767 E Imperial Hwy
Brea, CA 92821-6713
Phone
(714) 578-8720
NPI assigned
Jun 28, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 26, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Occupational Therapist 225XP0200X 2105 CA Primary

Addresses

Primary practice location

2767 E Imperial Hwy
Brea, CA 92821-6713

Mailing address

680 Langsdorf Dr
Ste 100
Fullerton, CA 92831-3702
Phone (714) 871-0460

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190822000908 CA Practitioner - Occupational Therapist in Private Practice 3678801115 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Occupational Therapist in Private Practice
Education
Other, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Matrix Physical Therapy and Wellness PCGroup PAC ID 7416243662, 14 clinicians

Practice addresses (Care Compare)

2730 Wilshire Blvd
Suite 105
Santa Monica, CA 90403-4724
Phone (949) 307-6857

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2105CAMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Fullerton Physical Therapy & Sports Care, Inc. CurrentSince Jul 15, 2021 Accepting new patients
Matrix Physical Therapy and Wellness, PC Pediatrics CurrentSince Oct 10, 2024 Accepting new patients

Locations

680 Langsdorf Dr
Ste 100
Fullerton, CA 92831
Phone (714) 871-0460

2730 Wilshire Blvd
Ste 105
Santa Monica, CA 90403
Phone (310) 310-2931

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1340841600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1627257600000",
    "number": "1740544311",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "680 LANGSDORF DR",
            "address_2": "STE 100",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "928313702",
            "telephone_number": "714-871-0460",
            "fax_number": "714-871-5342"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2767 E IMPERIAL HWY",
            "city": "BREA",
            "state": "CA",
            "postal_code": "928216713",
            "telephone_number": "714-578-8720"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SOESMAN",
        "first_name": "WENDY",
        "credential": "OTR/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-06-28",
        "last_updated": "2021-07-26",
        "certification_date": "2021-07-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225XP0200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Pediatrics",
            "state": "CA",
            "license": "2105",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brea, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.