Healthcare Provider Details

I. General information

NPI: 1407796873
Provider Name (Legal Business Name): LYDIA CLARK SEELY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2026
Last Update Date: 03/28/2026
Certification Date: 03/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 WASHINGTON ST
GRASS VALLEY CA
95945-6333
US

IV. Provider business mailing address

401 WASHINGTON ST
GRASS VALLEY CA
95945-6333
US

V. Phone/Fax

Practice location:
  • Phone: 530-263-7707
  • Fax:
Mailing address:
  • Phone: 530-263-7707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number12579
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: