Provider Demographics
NPI:1700203718
Name:CALIBOSO, SHEILA GRACE CLARAVALL (OTR/L)
Entity Type:Individual
Prefix:
First Name:SHEILA GRACE
Middle Name:CLARAVALL
Last Name:CALIBOSO
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:SHEILA GRACE
Other - Middle Name:CASTANEDA
Other - Last Name:CLARAVALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2819 CROW CANYON RD STE 205
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-1656
Mailing Address - Country:US
Mailing Address - Phone:510-852-9417
Mailing Address - Fax:
Practice Address - Street 1:2819 CROW CANYON RD
Practice Address - Street 2:# 205
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583
Practice Address - Country:US
Practice Address - Phone:925-264-9810
Practice Address - Fax:925-263-1906
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-27
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13599225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics