Healthcare Provider Details

I. General information

NPI: 1407790884
Provider Name (Legal Business Name): KATELYN ANG DAGDAG MA, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2026
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10125 S DE ANZA BLVD
CUPERTINO CA
95014-2105
US

IV. Provider business mailing address

10125 S DE ANZA BLVD
CUPERTINO CA
95014-2105
US

V. Phone/Fax

Practice location:
  • Phone: 408-865-1365
  • Fax: 408-549-9991
Mailing address:
  • Phone: 408-865-1365
  • Fax: 408-549-9991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number28812
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: