Healthcare Provider Details

I. General information

NPI: 1437085669
Provider Name (Legal Business Name): TIFFANY NG OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29516 KOHOUTEK WAY
UNION CITY CA
94587-1221
US

IV. Provider business mailing address

19606 PARSONS AVE
CASTRO VALLEY CA
94546-3421
US

V. Phone/Fax

Practice location:
  • Phone: 510-441-8240
  • Fax:
Mailing address:
  • Phone: 510-221-7187
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number24996
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: