=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619311073
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RHIANA GULESSERIAN CONE MS, OTR/L
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/29/2013
-----------------------------------------------------
Last Update Date | 04/29/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1500 RIVER ROAD
-----------------------------------------------------
City | BROOKDALE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95007-0263
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-342-7748
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 263
-----------------------------------------------------
City | BROOKDALE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95007-0263
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 11859
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------