Healthcare Provider Details

I. General information

NPI: 1265817597
Provider Name (Legal Business Name): KATHRYN A. HAVIS-FALER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2015
Last Update Date: 07/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1990 FRUITDALE AVE
SAN JOSE CA
95128-2709
US

IV. Provider business mailing address

1720 MOROCCO DR
SAN JOSE CA
95125-5823
US

V. Phone/Fax

Practice location:
  • Phone: 408-998-8447
  • Fax:
Mailing address:
  • Phone: 408-439-3305
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number3724
License Number StateCA

VIII. Authorized Official

Name: KATHRYN A HAVIS-FALER
Title or Position: OCCUPATIONAL THERAPIST
Credential: OTR/L
Phone: 916-835-2002