Healthcare Provider Details

I. General information

NPI: 1386960730
Provider Name (Legal Business Name): JUDITH B. NYCHAY OT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2010
Last Update Date: 04/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4442 PIEDMONT AVE
OAKLAND CA
94611-4231
US

IV. Provider business mailing address

1805 BAY ST
ALAMEDA CA
94501-1104
US

V. Phone/Fax

Practice location:
  • Phone: 510-388-3664
  • Fax:
Mailing address:
  • Phone: 510-517-7951
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number6479
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number6479
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: