Healthcare Provider Details

I. General information

NPI: 1629853791
Provider Name (Legal Business Name): KARLEY ANNE BRUUN-ANDERSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2023
Last Update Date: 08/28/2023
Certification Date: 08/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 E THOUSAND OAKS BLVD STE 100
THOUSAND OAKS CA
91360-7708
US

IV. Provider business mailing address

223 E THOUSAND OAKS BLVD STE 100
THOUSAND OAKS CA
91360-7708
US

V. Phone/Fax

Practice location:
  • Phone: 805-418-9952
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number25414
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: