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General NPI Number Information
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NPI Number | 1073936498
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Entity Type | Individual
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Provider Name | LASHONDA PETRY OTR/L
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Gender | Female
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Dates
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Enumeration Date | 01/22/2014
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Last Update Date | 01/22/2014
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Provider Practice Location Address
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Address Line | 39180 FARWELL DR STE 211
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City | FREMONT
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State | CA
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Zip | 94538-1015
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Country | US
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Telephone | 510-857-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 4046A TRIPOLI DR
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City | ALAMEDA
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State | CA
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Zip | 94501-8015
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Country | US
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Telephone | 817-823-2229
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | OT13278
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License Number State | CA
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