Provider Demographics
NPI:1679124804
Name:SCRUGGS, VERONICA (MA, OTR/L)
Entity type:Individual
Prefix:
First Name:VERONICA
Middle Name:
Last Name:SCRUGGS
Suffix:
Gender:F
Credentials:MA, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1070 APPLE CT
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94518-3101
Mailing Address - Country:US
Mailing Address - Phone:949-310-5524
Mailing Address - Fax:
Practice Address - Street 1:3700 DELTA FAIR BLVD STE A1
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509-4019
Practice Address - Country:US
Practice Address - Phone:925-586-6407
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-29
Last Update Date:2019-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7827225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist