Healthcare Provider Details

I. General information

NPI: 1891406807
Provider Name (Legal Business Name): ZOE DESAULNIER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2022
Last Update Date: 06/11/2024
Certification Date: 06/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8911 LAKEWOOD DR STE 24H
WINDSOR CA
95492-7856
US

IV. Provider business mailing address

8911 LAKEWOOD DR STE 25C
WINDSOR CA
95492-7856
US

V. Phone/Fax

Practice location:
  • Phone: 707-200-8367
  • Fax:
Mailing address:
  • Phone: 707-200-8367
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number14585
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: