Healthcare Provider Details

I. General information

NPI: 1184895195
Provider Name (Legal Business Name): THOMAS PAUL PASSERINO OTR/L
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2008
Last Update Date: 01/13/2022
Certification Date: 01/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3738 WALNUT AVE
CARMICHAEL CA
95608-3099
US

IV. Provider business mailing address

3738 WALNUT AVE
CARMICHAEL CA
95608-3099
US

V. Phone/Fax

Practice location:
  • Phone: 916-971-7700
  • Fax:
Mailing address:
  • Phone: 916-971-7700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number2192
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: