Healthcare Provider Details

I. General information

NPI: 1922372408
Provider Name (Legal Business Name): BRIGHT S SEWOR OTR/L
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2012
Last Update Date: 03/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2315 STOCKTON BLVD
SACRAMENTO CA
95817-2201
US

IV. Provider business mailing address

2315 STOCKTON BLVD
SACRAMENTO CA
95817-2201
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-7040
  • Fax:
Mailing address:
  • Phone: 916-734-7040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT 9495
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: