Provider Demographics
NPI:1043069131
Name:TATEVOSYAN, MAGE (OTR/L)
Entity type:Individual
Prefix:
First Name:MAGE
Middle Name:
Last Name:TATEVOSYAN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:MAGGIE
Other - Middle Name:
Other - Last Name:TATEVOSYAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR/L
Mailing Address - Street 1:1241 HIBISCUS WAY
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94551-1313
Mailing Address - Country:US
Mailing Address - Phone:818-445-4111
Mailing Address - Fax:
Practice Address - Street 1:140 TOWN AND COUNTRY DR
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:CA
Practice Address - Zip Code:94526-3893
Practice Address - Country:US
Practice Address - Phone:925-743-8905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-13
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16223225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand