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NPI Code Detail

MEDICARE: NISHA KANTIDEV PATEL-VENKETSAMY O.T.

MEDICARE: NISHA KANTIDEV PATEL-VENKETSAMY O.T.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational TherapistOT2828CA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2P01003597OTHERCAMEDICARE RAILROAD

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1OT2828OTHERCAMEDICAL LICENSE

General Provider Information

NPI Number : 1376836155
Entity Type Code : Individual
Provider Name (Legal Business Name) : NISHA KANTIDEV PATEL-VENKETSAMY O.T.
Provider Business Mailing Address
First Line : 4626 WILLOW RD
Second Line : SUITE 200
City : PLEASANTON
State : CA
Zip : 94588-8517
Country : US
Telephone Number : 925-463-0470
Fax Number : 925-463-0473
Provider Business Practice Location Address
First Line : 4626 WILLOW RD
Second Line : SUITE 200
City : PLEASANTON
State : CA
Zip : 94588-8517
Country : US
Telephone Number : 925-463-0470
Fax Number : 925-463-0473
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/26/2011
Last Update Date : 01/11/2022

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Directions to “ NISHA KANTIDEV PATEL-VENKETSAMY O.T.” Practice Location

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