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: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3345 GRAND AVE STE 1
OAKLAND CA
94610-2772
US

IV. Provider business mailing address

3345 GRAND AVE STE 1
OAKLAND CA
94610-2772
US

V. Phone/Fax

Practice location:
  • Phone: 510-774-2755
  • Fax:
Mailing address:
  • Phone: 510-774-2755
  • Fax: 888-796-1423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XE0001X
TaxonomyEnvironmental Modification Occupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225XE1200X
TaxonomyErgonomics Occupational Therapist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

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