Provider Demographics
NPI:1396113171
Name:TSE, TINNY TAN (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:TINNY
Middle Name:TAN
Last Name:TSE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:TINNY
Other - Middle Name:
Other - Last Name:TAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:1300 PALOS VERDES DR APT 12
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94403-3784
Mailing Address - Country:US
Mailing Address - Phone:415-810-6924
Mailing Address - Fax:
Practice Address - Street 1:499 BLOSSOM HILL RD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95123-1550
Practice Address - Country:US
Practice Address - Phone:408-268-8536
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-09
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15581225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist