Healthcare Provider Details

I. General information

NPI: 1659864106
Provider Name (Legal Business Name): KELSEY ANNE PAGE OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2018
Last Update Date: 06/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2398 PINE ST
SAN FRANCISCO CA
94115-2715
US

IV. Provider business mailing address

2595 CLAY ST APT 8
SAN FRANCISCO CA
94115-1838
US

V. Phone/Fax

Practice location:
  • Phone: 415-913-7676
  • Fax:
Mailing address:
  • Phone: 415-306-1457
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number18524
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: