Provider Demographics
NPI:1730139643
Name:SAKALDASIS, ELIZABETH (MA, OTR/L, CHT)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:SAKALDASIS
Suffix:
Gender:F
Credentials:MA, OTR/L, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 PORTER DR
Mailing Address - Street 2:215
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-1587
Mailing Address - Country:US
Mailing Address - Phone:925-362-2166
Mailing Address - Fax:855-574-3055
Practice Address - Street 1:3300 WEBSTER ST
Practice Address - Street 2:1201
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3117
Practice Address - Country:US
Practice Address - Phone:510-486-2300
Practice Address - Fax:510-486-2333
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2017-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1764225X00000X
CA1041100347225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP01564250Medicare PIN
CAGQ715ZMedicare PIN