Healthcare Provider Details

I. General information

NPI: 1376012179
Provider Name (Legal Business Name): ALLISON GAUGHAN MS, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2018
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10125 S DE ANZA BLVD
CUPERTINO CA
95014-2105
US

IV. Provider business mailing address

325 UNION AVE APT 251
CAMPBELL CA
95008-4265
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number6704
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: