Individual
TRISTIKA WEAVER-MADDOX
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
144 CONTINENTE AVE STE 100, BRENTWOOD, CA 94513-7102
(925) 513-2440
Mailing address
144 CONTINENTE AVE STE 100, BRENTWOOD, CA 94513-7102
(925) 513-2440
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA3892
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OTA3892
OCCUPATIONAL THERAPY
—
Enumeration date
08/10/2018
Last updated
08/10/2018
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