Provider Demographics
NPI:1669673992
Name:NG, SHIRLEY (OCCUPATIONAL THERAPI)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:
Last Name:NG
Suffix:
Gender:F
Credentials:OCCUPATIONAL THERAPI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47592 AVALON HEIGHTS TER
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94539-8363
Mailing Address - Country:US
Mailing Address - Phone:510-490-8225
Mailing Address - Fax:510-490-8225
Practice Address - Street 1:7200 BANCROFT AVE
Practice Address - Street 2:STE 125A
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94605-2403
Practice Address - Country:US
Practice Address - Phone:510-777-3859
Practice Address - Fax:510-777-3806
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT 8826225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist