Provider Demographics
NPI:1124279518
Name:OBUSAN, OLIVER ZANTUA (OTR/L)
Entity type:Individual
Prefix:MR
First Name:OLIVER
Middle Name:ZANTUA
Last Name:OBUSAN
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2384 KENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-1334
Mailing Address - Country:US
Mailing Address - Phone:408-334-5708
Mailing Address - Fax:
Practice Address - Street 1:2384 KENWOOD AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-1334
Practice Address - Country:US
Practice Address - Phone:408-334-5708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-04
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11073225X00000X
MD211161225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist