Healthcare Provider Details

I. General information

NPI: 1477400786
Provider Name (Legal Business Name): JARED EDWARD BAGUE OTR/L, OTD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2026
Last Update Date: 03/16/2026
Certification Date: 03/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 SILVER AVE
SAN FRANCISCO CA
94112-1510
US

IV. Provider business mailing address

71 HAROLD AVE
SAN FRANCISCO CA
94112-2331
US

V. Phone/Fax

Practice location:
  • Phone: 415-334-2500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number28683
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: