Provider Demographics
NPI:1508272725
Name:SSENSALO, ANNA NANSAMBA (OTR/L)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:NANSAMBA
Last Name:SSENSALO
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 1:670 APGAR ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-2344
Mailing Address - Country:US
Mailing Address - Phone:510-290-9858
Mailing Address - Fax:
Practice Address - Street 1:670 APGAR ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-2344
Practice Address - Country:US
Practice Address - Phone:510-290-9858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-08
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14354225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist