Healthcare Provider Details

I. General information

NPI: 1053607374
Provider Name (Legal Business Name): ANGELA ALLISON TINSON OTR/L, CHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2011
Last Update Date: 04/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2039 FOREST AVE 104
SAN JOSE CA
95128-4817
US

IV. Provider business mailing address

1450 VETERANS BLVD STE 110
REDWOOD CITY CA
94063-2619
US

V. Phone/Fax

Practice location:
  • Phone: 408-279-8501
  • Fax: 408-279-8504
Mailing address:
  • Phone: 408-733-3670
  • Fax: 408-245-7968

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number6589
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: