Provider Demographics
NPI:1831857713
Name:LU CASTELLE, EMILY JEAN (OTR/L)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:JEAN
Last Name:LU CASTELLE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:JEAN
Other - Last Name:LU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1145 FENCE POST WAY
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95747-4312
Mailing Address - Country:US
Mailing Address - Phone:408-605-6981
Mailing Address - Fax:
Practice Address - Street 1:2020 TOWN CENTER WEST WAY
Practice Address - Street 2:
Practice Address - City:EL DORADO HILLS
Practice Address - State:CA
Practice Address - Zip Code:95762-7575
Practice Address - Country:US
Practice Address - Phone:916-999-7230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-07
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17980225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist