Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OT 747 | CA |
N | 225XG0600X | Occupational Therapist - Gerontology | OT 747 | CA |
N | 225XM0800X | Mental Health | OT 747 | CA |
N | 225XN1300X | Occupational Therapist - Neurorehabilitation | OT 747 | CA |
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | OT 747 | CA |
NPI | 1346567021 |
---|---|
Provider Name | Mr. Richard Caccamo |
First Address | San Pablo, CA 94806 |
Second Address | San Pablo, CA 94806 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/04/2010 |
Last Update Date | 21/04/2010 |