Provider Demographics
NPI:1689374407
Name:SANTIAGO, MAI (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:MAI
Middle Name:
Last Name:SANTIAGO
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 1:1938 FAIRBANKS ST
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577-3121
Mailing Address - Country:US
Mailing Address - Phone:510-612-9434
Mailing Address - Fax:
Practice Address - Street 1:14207 E 14TH ST
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94578-2709
Practice Address - Country:US
Practice Address - Phone:510-220-9578
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-09
Last Update Date:2023-09-28
Deactivation Date:2023-08-13
Deactivation Code:
Reactivation Date:2023-09-28
Provider Licenses
StateLicense IDTaxonomies
CA24424225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist