Healthcare Provider Details

I. General information

NPI: 1356670723
Provider Name (Legal Business Name): KATHLEEN MORGAN THOMAS M.A. OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2009
Last Update Date: 12/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 PARKMOOR AVE SUITE A 0149
SAN JOSE CA
95128-2420
US

IV. Provider business mailing address

1023 WOODBINE WAY
SAN JOSE CA
95117-2965
US

V. Phone/Fax

Practice location:
  • Phone: 408-829-7472
  • Fax:
Mailing address:
  • Phone: 408-985-5298
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT 5839
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: