Provider Demographics
NPI:1508391657
Name:YEKTA, YALDA (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:YALDA
Middle Name:
Last Name:YEKTA
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2208 CAMINO RAMON STE B
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-1328
Mailing Address - Country:US
Mailing Address - Phone:925-830-5133
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:925-830-5133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-26
Last Update Date:2017-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17733225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist