Healthcare Provider Details

I. General information

NPI: 1245119692
Provider Name (Legal Business Name): OT BAY AREA PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2025
Last Update Date: 08/29/2025
Certification Date: 08/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

58 W PORTAL AVE # 532
SAN FRANCISCO CA
94127-1304
US

IV. Provider business mailing address

58 W PORTAL AVE # 532
SAN FRANCISCO CA
94127-1304
US

V. Phone/Fax

Practice location:
  • Phone: 415-236-2030
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XM0800X
TaxonomyMental Health Occupational Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: SHEELA IVLEV
Title or Position: OWNER
Credential: OTR/L
Phone: 415-236-2030