Provider Demographics
NPI:1245363704
Name:CULLINEN, SANDI (OTR, CHT)
Entity type:Individual
Prefix:
First Name:SANDI
Middle Name:
Last Name:CULLINEN
Suffix:
Gender:F
Credentials:OTR, CHT
Other - Prefix:
Other - First Name:SANDI
Other - Middle Name:LOEWEN
Other - Last Name:CULLINEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR, CHT
Mailing Address - Street 1:7950 REDWOOD DR
Mailing Address - Street 2:SUITE 13
Mailing Address - City:COTATI
Mailing Address - State:CA
Mailing Address - Zip Code:94931-3051
Mailing Address - Country:US
Mailing Address - Phone:707-792-1370
Mailing Address - Fax:707-792-1362
Practice Address - Street 1:7950 REDWOOD DR
Practice Address - Street 2:SUITE 13
Practice Address - City:COTATI
Practice Address - State:CA
Practice Address - Zip Code:94931-3051
Practice Address - Country:US
Practice Address - Phone:707-792-1370
Practice Address - Fax:707-792-1362
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2009-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA509225XH1200X, 225XR0403X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
No225XR0403XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistDriving and Community Mobility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOT005080OtherBLUE SHIELD
CANONEOtherDEPT. OF LABOR
CAOT005080OtherBLUE SHIELD
CA6142390001Medicare NSC