Provider Demographics
NPI:1033963335
Name:OKOOMIAN, MICHELE ANN (COTA/L, CDP, CFPS)
Entity Type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:ANN
Last Name:OKOOMIAN
Suffix:
Gender:F
Credentials:COTA/L, CDP, CFPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7960 SOQUEL DR STE B244
Mailing Address - Street 2:
Mailing Address - City:APTOS
Mailing Address - State:CA
Mailing Address - Zip Code:95003-3999
Mailing Address - Country:US
Mailing Address - Phone:401-301-1150
Mailing Address - Fax:
Practice Address - Street 1:7960 SOQUEL DR STE B244
Practice Address - Street 2:
Practice Address - City:APTOS
Practice Address - State:CA
Practice Address - Zip Code:95003-3999
Practice Address - Country:US
Practice Address - Phone:401-301-1150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1816225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist