Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
MISTY RENAE BLACK, PTA
ActiveMISTY RENAE BLACK, PTA is a Occupational Therapist healthcare provider located in SEBASTOPOL, California. NPI 1043386220 is currently active in the NPPES registry. Verify at CMS.
Occupational Therapist · SEBASTOPOL, CA
Registration Details
- NPI Number
- 1043386220
- Provider Type
- Individual
- Gender
- Female
- NPI Issued
- Nov 28, 2006 (19.715343337245 yrs)
- Last Updated
- Mar 1, 2022
- Licenses
-
AT6901 (CA)AT6901 (CA)
Practice Information
- Address
-
100 PLEASANT HILL AVE NSEBASTOPOL, CA, 954723104Browse CA providers · Browse ZIP 95472
- Phone
- 7078293282
- Fax
- 7078293287
- Primary Specialty
-
Occupational Therapist
225200000X
- Additional Specialty
- Physical Therapy Assistant
Other Occupational Therapist Providers in SEBASTOPOL, CA
| Name | Credential | NPI |
|---|---|---|
| MRS. HOLLY ANN MATTICOLA | P.T.A. | 1417283383 |
| KYLE RUDDEROW | — | 1477200962 |
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.