Healthcare Provider Details

I. General information

NPI: 1376836155
Provider Name (Legal Business Name): NISHA KANTIDEV PATEL-VENKETSAMY O.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NISHA KANTIDEV PATEL

II. Dates (important events)

Enumeration Date: 05/26/2011
Last Update Date: 01/11/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4626 WILLOW RD SUITE 200
PLEASANTON CA
94588-8517
US

IV. Provider business mailing address

4626 WILLOW RD SUITE 200
PLEASANTON CA
94588-8517
US

V. Phone/Fax

Practice location:
  • Phone: 925-463-0470
  • Fax: 925-463-0473
Mailing address:
  • Phone: 925-463-0470
  • Fax: 925-463-0473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT2828
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: