Healthcare Provider Details

I. General information

NPI: 1649522780
Provider Name (Legal Business Name): ERICA PETERSON MOTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2012
Last Update Date: 01/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2819 CROW CANYON RD #205
SAN RAMON CA
94583-1655
US

IV. Provider business mailing address

3405 NORTON WAY 1
PLEASANTON CA
94566-4910
US

V. Phone/Fax

Practice location:
  • Phone: 925-264-9810
  • Fax:
Mailing address:
  • Phone: 925-784-0450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT 12651
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: