Provider Demographics
NPI:1316692247
Name:FALL-BROOKS, ANJELICA PATRICIA (OTR/L)
Entity type:Individual
Prefix:
First Name:ANJELICA
Middle Name:PATRICIA
Last Name:FALL-BROOKS
Suffix:
Gender:F
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 1:3687 MT DIABLO BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CA
Mailing Address - Zip Code:94549-3777
Mailing Address - Country:US
Mailing Address - Phone:925-954-4546
Mailing Address - Fax:925-415-6046
Practice Address - Street 1:3687 MT DIABLO BLVD STE 100
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CA
Practice Address - Zip Code:94549-3777
Practice Address - Country:US
Practice Address - Phone:925-954-4546
Practice Address - Fax:925-415-6046
Is Sole Proprietor?:No
Enumeration Date:2022-02-18
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22212225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics