MEDICARE: MS. SUE M HENRY O.T.R/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225XP0200X	Pediatric Occupational Therapist	1899	CA

General Provider Information

NPI Number	:	1588917058
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SUE M HENRY O.T.R/L

Provider Business Mailing Address
First Line	:	2109 OTOOLE AVE STE M
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95131-1338
Country	:	US
Telephone Number	:	408-573-7720
Fax Number	:	408-753-9555

Provider Business Practice Location Address
First Line	:	2109 OTOOLE AVE STE M
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95131-1338
Country	:	US
Telephone Number	:	408-573-7720
Fax Number	:	408-753-9555

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/22/2012
Last Update Date	:	02/20/2026

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