Provider Demographics
NPI:1457699803
Name:OFVERBERG, ANNIKA CHRISTINA (OTL)
Entity type:Individual
Prefix:
First Name:ANNIKA
Middle Name:CHRISTINA
Last Name:OFVERBERG
Suffix:
Gender:F
Credentials:OTL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 DELYNN WAY
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95125-3620
Mailing Address - Country:US
Mailing Address - Phone:707-280-6923
Mailing Address - Fax:408-622-8274
Practice Address - Street 1:1105 DELYNN WAY
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95125-3620
Practice Address - Country:US
Practice Address - Phone:707-280-6923
Practice Address - Fax:408-622-8274
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-18
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4390225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist