Healthcare Provider Details

I. General information

NPI: 1609831767
Provider Name (Legal Business Name): KAREN VAN VALKENBURG OTR/L, CHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 11/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 PICKERING CIRCLE
LADERA RANCH CA
92694
US

IV. Provider business mailing address

11 PICKERING CIR
LADERA RANCH CA
92694-0525
US

V. Phone/Fax

Practice location:
  • Phone: -55-5555
  • Fax: -44-4444
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License NumberOT 5628
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: