Provider Demographics
NPI:1396198586
Name:SEALE, EMMA
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:
Last Name:SEALE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 BUDD AVE APT B8
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-4023
Mailing Address - Country:US
Mailing Address - Phone:805-403-0812
Mailing Address - Fax:
Practice Address - Street 1:350 BUDD AVE APT B8
Practice Address - Street 2:
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-4023
Practice Address - Country:US
Practice Address - Phone:805-403-0812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-22
Last Update Date:2016-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16483225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist