Healthcare Provider Details

I. General information

NPI: 1437571973
Provider Name (Legal Business Name): JOANNA DISHMAN OTR/L, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2014
Last Update Date: 01/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2819 CROW CANYON RD STE 205
SAN RAMON CA
94583-1656
US

IV. Provider business mailing address

2819 CROW CANYON RD STE 205
SAN RAMON CA
94583-1656
US

V. Phone/Fax

Practice location:
  • Phone: 925-264-9810
  • Fax: 925-263-1906
Mailing address:
  • Phone: 925-264-9810
  • Fax: 925-263-1906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number00013540
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: