Healthcare Provider Details

I. General information

NPI: 1922708791
Provider Name (Legal Business Name): NATALIE LYNNE MACNEILL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2023
Last Update Date: 03/09/2023
Certification Date: 03/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1535 RIVER PARK DR
SACRAMENTO CA
95815-4601
US

IV. Provider business mailing address

4300 SATILLIA CT
ELK GROVE CA
95758-3803
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-6700
  • Fax:
Mailing address:
  • Phone: 916-730-1724
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2925
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number2925
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: