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General NPI Number Information
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NPI Number | 1548115330
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Entity Type | Individual
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Provider Name | GRACE CONNOLLY
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Gender |
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Dates
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Enumeration Date | 02/27/2026
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Last Update Date | 02/27/2026
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Provider Practice Location Address
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Address Line | 2900 PINOLE VALLEY RD # C209
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City | PINOLE
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State | CA
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Zip | 94564-1429
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Country | US
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Telephone | 510-502-7163
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Fax |
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Provider Business Mailing Address
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Address Line | 5558 CLAREMONT AVE
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City | OAKLAND
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State | CA
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Zip | 94618-1117
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Country | US
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Telephone | 510-502-7163
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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 | 24485
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License Number State | CA
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