Healthcare Provider Details

I. General information

NPI: 1558576892
Provider Name (Legal Business Name): ADI SHAKTI OT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KATHY SUE OVERSTREET OT

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 10/31/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1785 SAN CARLOS AVENUE SUITE 6
SAN CARLOS CA
94070-2026
US

IV. Provider business mailing address

778 COLEMAN AVENUE APT C
MENLO PARK CA
94025-2473
US

V. Phone/Fax

Practice location:
  • Phone: 510-501-9835
  • Fax:
Mailing address:
  • Phone: 408-464-1920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT3565
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code225XM0800X
TaxonomyMental Health Occupational Therapist
License NumberOT3565
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: