Healthcare Provider Details

I. General information

NPI: 1336032176
Provider Name (Legal Business Name): ANA WU MOT, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2025
Last Update Date: 05/30/2025
Certification Date: 05/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 SONOMA AVE
MODESTO CA
95355-3922
US

IV. Provider business mailing address

17020 RAIL WAY
LATHROP CA
95330-8642
US

V. Phone/Fax

Practice location:
  • Phone: 209-558-8118
  • Fax:
Mailing address:
  • Phone: 415-990-5693
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT12037
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: