Provider Demographics
NPI:1639222326
Name:READ-ROCKWELL, TRUDIE NICOLE (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:TRUDIE
Middle Name:NICOLE
Last Name:READ-ROCKWELL
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MS
Other - First Name:TRUDIE
Other - Middle Name:NICOLE
Other - Last Name:READ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:52 VIA LA CUMBRE
Mailing Address - Street 2:
Mailing Address - City:GREENBRAE
Mailing Address - State:CA
Mailing Address - Zip Code:94904-1345
Mailing Address - Country:US
Mailing Address - Phone:415-521-4133
Mailing Address - Fax:
Practice Address - Street 1:52 VIA LA CUMBRE
Practice Address - Street 2:
Practice Address - City:GREENBRAE
Practice Address - State:CA
Practice Address - Zip Code:94904-1345
Practice Address - Country:US
Practice Address - Phone:415-521-4133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16555225X00000X
WAOT00003597225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0039584OtherLABOR AND INDUSTRIES #
WA1929REOtherBLUE SHIELD#
WA8440497Medicaid
Q53028Medicare UPIN
WA8440497Medicaid