Individual
MRS. GRACE ELISE SHANDALOV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
24 ZANDER DRIVE, ORINDA, CA 94563
(925) 683-7144
Mailing address
24 ZANDER DR, ORINDA, CA 94563-3625
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
11581
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
82-1782711
—
CA
Enumeration date
06/08/2017
Last updated
06/16/2018
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