Provider Demographics
NPI:1093236655
Name:STUART, RHONDA DELORES (OTR/L)
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:DELORES
Last Name:STUART
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1640 CORTE DE PONS
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124-4805
Mailing Address - Country:US
Mailing Address - Phone:408-497-2255
Mailing Address - Fax:
Practice Address - Street 1:1640 CORTE DE PONS
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-4805
Practice Address - Country:US
Practice Address - Phone:408-497-2255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17537225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist