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General NPI Number Information
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NPI Number | 1376184812
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Entity Type | Organization
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Legal Business Name | ADAPTIVE AGING
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Dates
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Enumeration Date | 10/07/2019
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Last Update Date | 10/07/2019
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Provider Practice Location Address
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Address Line | 6210 CHATTSWOOD DR
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City | MARTINEZ
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State | CA
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Zip | 94553-6049
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Country | US
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Telephone | 510-508-3736
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Fax |
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Provider Business Mailing Address
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Address Line | 6210 CHATTSWOOD DR
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City | MARTINEZ
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State | CA
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Zip | 94553-6049
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Country | US
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Telephone | 510-508-3736
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Fax |
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Authorized Official
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Title or Position | OCCUPATIONAL THERAPIST
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Name | ALEXANDRA ANTON
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Credential | OTR/L
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Telephone | 510-508-3736
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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 |
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License Number State |
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