Healthcare Provider Details

I. General information

NPI: 1649244708
Provider Name (Legal Business Name): NANCY ANN REDDEN O.T.R.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2505 W 14TH ST
OAKLAND CA
94607-5031
US

IV. Provider business mailing address

2095 THOMAS AVE
SAN LEANDRO CA
94577-6122
US

V. Phone/Fax

Practice location:
  • Phone: 510-587-3436
  • Fax:
Mailing address:
  • Phone: 510-351-4121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number737
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: