Healthcare Provider Details

I. General information

NPI: 1902344419
Provider Name (Legal Business Name): JOSEPH RYAN OTR/L
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2017
Last Update Date: 03/01/2024
Certification Date: 03/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2343 35TH AVE
SAN FRANCISCO CA
94116-2244
US

IV. Provider business mailing address

1 APPIAN WAY 705-4
SOUTH SAN FRANCSICO CA
94080
US

V. Phone/Fax

Practice location:
  • Phone: 626-614-4247
  • Fax:
Mailing address:
  • Phone: 415-498-0716
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number21020
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: