Healthcare Provider Details

I. General information

NPI: 1538670773
Provider Name (Legal Business Name): KALINA KOTSEVA MSCA, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2017
Last Update Date: 08/05/2020
Certification Date: 08/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1335 SAN CARLOS AVE STE A
SAN CARLOS CA
94070-5604
US

IV. Provider business mailing address

120 SANTA LUCIA AVE APT 1
SAN BRUNO CA
94066-5223
US

V. Phone/Fax

Practice location:
  • Phone: 650-592-1819
  • Fax: 650-592-1819
Mailing address:
  • Phone: 415-653-2990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number16618
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: