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General NPI Number Information
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NPI Number | 1861638728
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Entity Type | Individual
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Provider Name | SHIVETTI B OSSOME MS, OCC. THERAPIST
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Gender | Female
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Dates
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Enumeration Date | 12/25/2008
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Last Update Date | 12/25/2008
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Provider Practice Location Address
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Address Line | 4813 TEGAN RD
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City | ELK GROVE
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State | CA
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Zip | 95758-5149
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Country | US
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Telephone | 916-427-5613
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Fax |
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Provider Business Mailing Address
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Address Line | 4813 TEGAN RD
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City | ELK GROVE
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State | CA
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Zip | 95758-5149
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Country | US
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Telephone | 916-427-5613
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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 | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | OT 1173
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | OT 1173
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 261QR0401X
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Taxonomy Name | Comprehensive Outpatient Rehabilitation Facility (CORF)
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License Number | OT 1173
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | OT 1173
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License Number State | CA
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