Healthcare Provider Details

I. General information

NPI: 1598132813
Provider Name (Legal Business Name): SASHA WANG OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2015
Last Update Date: 09/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4341 PIEDMONT AVE STE 3
OAKLAND CA
94611-4767
US

IV. Provider business mailing address

4341 PIEDMONT AVE STE 3
OAKLAND CA
94611-4767
US

V. Phone/Fax

Practice location:
  • Phone: 510-333-4579
  • Fax: 510-740-3491
Mailing address:
  • Phone: 510-333-4579
  • Fax: 510-740-3491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number15085
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: