MEDICARE: SUZANNE LEILANI KIRBY OTR

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
1	225X00000X	Occupational Therapist	1164	CA

General Provider Information

NPI Number	:	1427268895
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUZANNE LEILANI KIRBY OTR

Provider Business Mailing Address
First Line	:	1170 INNSBRUCK ST
Second Line	:
City	:	LIVERMORE
State	:	CA
Zip	:	94550
Country	:	US
Telephone Number	:	925-337-2580
Fax Number	:

Provider Business Practice Location Address
First Line	:	3717 CASTRO VALLEY BLVD
Second Line	:
City	:	CASTRO VALLEY
State	:	CA
Zip	:	94546-4405
Country	:	US
Telephone Number	:	510-538-3937
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2007
Last Update Date	:	07/08/2007

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