Healthcare Provider Details

I. General information

NPI: 1154613495
Provider Name (Legal Business Name): PEDIATRIC PATHWAYS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2011
Last Update Date: 05/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17400 MONTEREY RD STE 2E
MORGAN HILL CA
95037-7319
US

IV. Provider business mailing address

17400 MONTEREY RD STE 2E
MORGAN HILL CA
95037-7319
US

V. Phone/Fax

Practice location:
  • Phone: 408-778-6200
  • Fax: 408-484-1096
Mailing address:
  • Phone: 408-778-6200
  • Fax: 408-484-1096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT4831
License Number StateCA

VIII. Authorized Official

Name: MRS. ELIZABETH CLERK BELLIVEAU
Title or Position: OWNER/DIRECTOR
Credential: OTR/L
Phone: 408-778-6200