Healthcare Provider Details

I. General information

NPI: 1972079465
Provider Name (Legal Business Name): KAMRAN HUSAIN OTR/L
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2018
Last Update Date: 10/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 SILVEIRA PKWY
SAN RAFAEL CA
94903-4879
US

IV. Provider business mailing address

257 VERNON ST APT 207
OAKLAND CA
94610-4157
US

V. Phone/Fax

Practice location:
  • Phone: 415-499-1000
  • Fax:
Mailing address:
  • Phone: 155-959-3538
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number16423
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: