Healthcare Provider Details

I. General information

NPI: 1588976716
Provider Name (Legal Business Name): GURJEET KAUR SANDHU OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2010
Last Update Date: 02/11/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

975 SERENO DR
VALLEJO CA
94589-2441
US

IV. Provider business mailing address

6238 PEBBLE BEACH DR
VALLEJO CA
94591-6300
US

V. Phone/Fax

Practice location:
  • Phone: 707-651-1312
  • Fax:
Mailing address:
  • Phone: 408-603-9796
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License Number11195
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: