Healthcare Provider Details

I. General information

NPI: 1700710308
Provider Name (Legal Business Name): OVER THE WALL OCCUPATIONAL THERAPY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/14/2026
Certification Date: 06/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4420 MARSH ELDER CT
CONCORD CA
94521-4446
US

IV. Provider business mailing address

4420 MARSH ELDER CT
CONCORD CA
94521-4446
US

V. Phone/Fax

Practice location:
  • Phone: 415-599-6628
  • Fax:
Mailing address:
  • Phone: 415-599-6628
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH WALL
Title or Position: OWNER/ OCCUPATIONAL THERAPIST
Credential: OTR/L
Phone: 415-599-6628