Healthcare Provider Details

I. General information

NPI: 1356054035
Provider Name (Legal Business Name): SUDESHNA CHAKRABARTI OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2022
Last Update Date: 12/27/2022
Certification Date: 12/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1990 FRUITDALE AVE
SAN JOSE CA
95128-2709
US

IV. Provider business mailing address

1012 HARLAN CT
SAN JOSE CA
95129-3019
US

V. Phone/Fax

Practice location:
  • Phone: 408-998-8447
  • Fax:
Mailing address:
  • Phone: 248-470-7147
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT9344
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: