Individual
EDANA KISTAMPALLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
790 LETICA DR, ROCHESTER, MI 48307-1581
(408) 854-2007
Mailing address
2900 EAGLE ROCK RD, PENRYN, CA 95663-9623
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
326444
CA
Other
Enumeration date
08/25/2014
Last updated
09/01/2021
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