Provider Demographics
NPI:1245359835
Name:LEW, NANCY (OTR IL)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:LEW
Suffix:
Gender:F
Credentials:OTR IL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 SOUTHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94080-3106
Mailing Address - Country:US
Mailing Address - Phone:650-778-8795
Mailing Address - Fax:
Practice Address - Street 1:825 SOUTHWOOD DR
Practice Address - Street 2:
Practice Address - City:SOUTH SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94080-3106
Practice Address - Country:US
Practice Address - Phone:650-877-8795
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT7367225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
11457OtherCBHS INTERNAL USE ONLY-COMMERCIAL NUMBER
11457OtherSFGH INTERNAL USE ONLY