Active NPI
Chanelle Soer Bautista
- Occupational Therapist
- Palo Alto, CA
National Provider Identifier
1568238194
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 25733
- Practice address
- 620 Sand Hill Rd
Palo Alto, CA 94304-2002 - Phone
- (855) 916-5814
- NPI assigned
- Nov 27, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 25733 | CA | Primary |
Addresses
Primary practice location
620 Sand Hill Rd
Palo Alto, CA 94304-2002
Mailing address
2456 Driftwood Way
San Leandro, CA 94577-6516
Phone (510) 456-8634
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25733 | CA | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1701043200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1701388800000",
"number": "1568238194",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2456 DRIFTWOOD WAY",
"city": "SAN LEANDRO",
"state": "CA",
"postal_code": "945776516",
"telephone_number": "510-456-8634"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "620 SAND HILL RD",
"city": "PALO ALTO",
"state": "CA",
"postal_code": "943042002",
"telephone_number": "855-916-5814"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BAUTISTA",
"first_name": "CHANELLE",
"middle_name": "SOER",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-11-27",
"last_updated": "2023-12-01",
"certification_date": "2023-12-01",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "CA",
"license": "25733",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Palo Alto, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.