Healthcare Provider Details

I. General information

NPI: 1356680193
Provider Name (Legal Business Name): VENET CREMONA-THOMPSON OT/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: VENET THOMPSON OT/L

II. Dates (important events)

Enumeration Date: 02/13/2013
Last Update Date: 02/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1034 OAK GROVE RD
CONCORD CA
94518-3225
US

IV. Provider business mailing address

1034 OAK GROVE RD
CONCORD CA
94518-3225
US

V. Phone/Fax

Practice location:
  • Phone: 925-681-4450
  • Fax:
Mailing address:
  • Phone: 925-681-4450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XM0800X
TaxonomyMental Health Occupational Therapist
License NumberOT 481
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225XF0002X
TaxonomyFeeding, Eating & Swallowing Occupational Therapist
License NumberOT 481
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: