Provider Demographics
NPI:1992847677
Name:OMNI THERAPY SERVICES,INC
Entity Type:Organization
Organization Name:OMNI THERAPY SERVICES,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHANTI
Authorized Official - Middle Name:
Authorized Official - Last Name:MALLADI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-432-0114
Mailing Address - Street 1:200 BROWN RD
Mailing Address - Street 2:SIUTE # 204
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94539-7955
Mailing Address - Country:US
Mailing Address - Phone:510-432-0114
Mailing Address - Fax:510-578-7669
Practice Address - Street 1:10306 STARLIGHT PEAK DR
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93311-3076
Practice Address - Country:US
Practice Address - Phone:661-472-0373
Practice Address - Fax:661-654-0425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT 1524225X00000X
CASP 8678235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Not Answered235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty