Healthcare Provider Details

I. General information

NPI: 1508416694
Provider Name (Legal Business Name): EMILY LYNN SMILEY OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2019
Last Update Date: 09/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39400 PASEO PADRE PKWY
FREMONT CA
94538-2310
US

IV. Provider business mailing address

17500 EHLE ST APT 2
CASTRO VALLEY CA
94546-3866
US

V. Phone/Fax

Practice location:
  • Phone: 510-248-3000
  • Fax:
Mailing address:
  • Phone: 415-990-8461
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT16624
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: