Healthcare Provider Details

I. General information

NPI: 1982978201
Provider Name (Legal Business Name): ANN BAYCI ENGELGAU OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANN BAYCI CAMPBELL OTR/L

II. Dates (important events)

Enumeration Date: 03/05/2012
Last Update Date: 03/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 SARATOGA AVE APT. 4109
SANTA CLARA CA
95051-7348
US

IV. Provider business mailing address

121 SARATOGA AVE APT. 4109
SANTA CLARA CA
95051-7348
US

V. Phone/Fax

Practice location:
  • Phone: 248-854-5807
  • Fax:
Mailing address:
  • Phone: 248-854-5807
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number12388
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: