Healthcare Provider Details

I. General information

NPI: 1114482502
Provider Name (Legal Business Name): RENEE VRABLE OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2019
Last Update Date: 02/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

612 ENRIGHT AVE
SANTA CLARA CA
95050-6941
US

IV. Provider business mailing address

612 ENRIGHT AVE
SANTA CLARA CA
95050-6941
US

V. Phone/Fax

Practice location:
  • Phone: 650-504-7899
  • Fax:
Mailing address:
  • Phone: 650-504-7899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number18667
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: