Provider Demographics
NPI:1558576892
Name:SHAKTI, ADI (OT)
Entity type:Individual
Prefix:
First Name:ADI
Middle Name:
Last Name:SHAKTI
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:KATHY
Other - Middle Name:SUE
Other - Last Name:OVERSTREET
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:778 COLEMAN AVENUE APT C
Mailing Address - Street 2:
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-2473
Mailing Address - Country:US
Mailing Address - Phone:408-464-1920
Mailing Address - Fax:
Practice Address - Street 1:1785 SAN CARLOS AVENUE SUITE 6
Practice Address - Street 2:
Practice Address - City:SAN CARLOS
Practice Address - State:CA
Practice Address - Zip Code:94070-2026
Practice Address - Country:US
Practice Address - Phone:510-501-9835
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT3565225X00000X, 225XM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XM0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistMental Health
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist