Provider Demographics
NPI:1538770490
Name:CHINNASWAMY, UMA MAHESWARI
Entity type:Individual
Prefix:
First Name:UMA
Middle Name:MAHESWARI
Last Name:CHINNASWAMY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5858 MORGAN PL APT 8
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95219-4625
Mailing Address - Country:US
Mailing Address - Phone:707-317-8783
Mailing Address - Fax:
Practice Address - Street 1:4545 SHELLEY CT
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-7232
Practice Address - Country:US
Practice Address - Phone:209-477-0271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-13
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11300225X00000X
NY015771225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist