Healthcare Provider Details

I. General information

NPI: 1689357501
Provider Name (Legal Business Name): ERGOTHERAPY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2023
Last Update Date: 11/10/2023
Certification Date: 11/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3345 GRAND AVE STE 3
OAKLAND CA
94610-2772
US

IV. Provider business mailing address

490 LAKE PARK AVE UNIT 10583
OAKLAND CA
94610-8021
US

V. Phone/Fax

Practice location:
  • Phone: 510-774-2755
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PRICELDA CID
Title or Position: OWNER
Credential: OTR
Phone: 310-920-9104