Healthcare Provider Details

I. General information

NPI: 1700202405
Provider Name (Legal Business Name): MARY ELIZABETH SCHOLER OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2014
Last Update Date: 03/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 S BASCOM AVE SUITE 200
SAN JOSE CA
95128-3543
US

IV. Provider business mailing address

PO BOX 126
NEW ALMADEN CA
95042-0126
US

V. Phone/Fax

Practice location:
  • Phone: 408-559-9556
  • Fax: 669-231-4908
Mailing address:
  • Phone: 408-559-9556
  • Fax: 669-231-4908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number4215
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: