Provider Demographics
NPI:1487385761
Name:MEADOWS, DAMIEN KRISTOPHER (OTR/L)
Entity type:Individual
Prefix:
First Name:DAMIEN
Middle Name:KRISTOPHER
Last Name:MEADOWS
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:KRIS
Other - Middle Name:
Other - Last Name:MEADOWS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR/L
Mailing Address - Street 1:3266 WYMAN ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94619-3434
Mailing Address - Country:US
Mailing Address - Phone:415-418-8178
Mailing Address - Fax:
Practice Address - Street 1:14207 E 14TH ST
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94578-2709
Practice Address - Country:US
Practice Address - Phone:415-418-8178
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-18
Last Update Date:2022-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT16124225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics