Provider Demographics
NPI:1073806386
Name:ENCARNACION, SHEETAL MAHESH (OTR/L)
Entity Type:Individual
Prefix:
First Name:SHEETAL
Middle Name:MAHESH
Last Name:ENCARNACION
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:SHEETAL
Other - Middle Name:MAHESH
Other - Last Name:SHAH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:3601 JOHNSON CT
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94555-3159
Mailing Address - Country:US
Mailing Address - Phone:510-290-3149
Mailing Address - Fax:
Practice Address - Street 1:2208 CAMINO RAMON STE B
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-1328
Practice Address - Country:US
Practice Address - Phone:510-290-3149
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-19
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4401225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist