Provider Demographics
NPI:1568668051
Name:ENNS, SHIRLEY ILENE (OCCUPATIONAL THERAPI)
Entity Type:Individual
Prefix:MRS
First Name:SHIRLEY
Middle Name:ILENE
Last Name:ENNS
Suffix:
Gender:F
Credentials:OCCUPATIONAL THERAPI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1142 NEVADA AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95125-3327
Mailing Address - Country:US
Mailing Address - Phone:408-280-1365
Mailing Address - Fax:408-280-0366
Practice Address - Street 1:5000 HOPYARD RD STE 220
Practice Address - Street 2:CAREER STAFF UNLIMITED
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-3314
Practice Address - Country:US
Practice Address - Phone:800-493-2988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7545225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist