Healthcare Provider Details

I. General information

NPI: 1053595207
Provider Name (Legal Business Name): AMELIA GRACE FOOS O.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AMELIA GRACE HUNT MS, OTR/L

II. Dates (important events)

Enumeration Date: 12/24/2007
Last Update Date: 02/11/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 MERCED STREET
SAN LEANDRO CA
94577-4201
US

IV. Provider business mailing address

2500 MERCED STREET
SAN LEANDRO CA
94577-4201
US

V. Phone/Fax

Practice location:
  • Phone: 510-454-1000
  • Fax:
Mailing address:
  • Phone: 510-454-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number2992
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: