Healthcare Provider Details

I. General information

NPI: 1669265484
Provider Name (Legal Business Name): EMILY LOUISE KICH OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2025
Last Update Date: 05/24/2025
Certification Date: 05/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 ALHAMBRA AVE
MARTINEZ CA
94553-3156
US

IV. Provider business mailing address

660 FALLING STAR DR
MARTINEZ CA
94553-4841
US

V. Phone/Fax

Practice location:
  • Phone: 925-370-5758
  • Fax:
Mailing address:
  • Phone: 925-658-2238
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License NumberOT23587
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: