Provider Demographics
NPI:1740388222
Name:RACE, PAOLA F (OT)
Entity type:Individual
Prefix:
First Name:PAOLA
Middle Name:F
Last Name:RACE
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 FREESE CT
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-5400
Mailing Address - Country:US
Mailing Address - Phone:916-267-7741
Mailing Address - Fax:916-836-2222
Practice Address - Street 1:50 IRON POINT CIR STE 100
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-8594
Practice Address - Country:US
Practice Address - Phone:916-836-1111
Practice Address - Fax:916-836-2222
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT7317225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACT0073170Medicaid
ZZZ03351ZMedicare ID - Type Unspecified
CACT0073170Medicaid