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General NPI Number Information
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NPI Number | 1215494919
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Entity Type | Individual
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Provider Name | CHARAE MCCONNELL
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Gender | Female
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Dates
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Enumeration Date | 02/28/2019
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Last Update Date | 02/13/2020
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Provider Practice Location Address
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Address Line | 425 DIVISADERO ST STE 300
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City | SAN FRANCISCO
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State | CA
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Zip | 94117-2242
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Country | US
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Telephone | 415-551-0975
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Fax |
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Provider Business Mailing Address
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Address Line | 632 W 11TH ST STE 119
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City | TRACY
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State | CA
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Zip | 95376-3860
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Country | US
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Telephone | 209-237-2484
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT20713
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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