Provider Demographics
NPI:1912695511
Name:SHUKALIAK NEUFELD, THEA (OTR/L, OTD)
Entity Type:Individual
Prefix:
First Name:THEA
Middle Name:
Last Name:SHUKALIAK NEUFELD
Suffix:
Gender:F
Credentials:OTR/L, OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3357 VICTORIA AVE
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CA
Mailing Address - Zip Code:94549-4620
Mailing Address - Country:US
Mailing Address - Phone:415-691-5635
Mailing Address - Fax:
Practice Address - Street 1:3357 VICTORIA AVE
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CA
Practice Address - Zip Code:94549-4620
Practice Address - Country:US
Practice Address - Phone:415-691-5635
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20355225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics