Healthcare Provider Details

I. General information

NPI: 1558919712
Provider Name (Legal Business Name): FREDA CHAMBERLAIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2019
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2930 DOMINGO AVE # 1092
BERKELEY CA
94705-2454
US

IV. Provider business mailing address

49 SANCHEZ ST APT A
SAN FRANCISCO CA
94114-1102
US

V. Phone/Fax

Practice location:
  • Phone: 510-431-8114
  • Fax:
Mailing address:
  • Phone: 310-704-4351
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number24575
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: