Healthcare Provider Details

I. General information

NPI: 1043967839
Provider Name (Legal Business Name): KATHERINE D TAO OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2022
Last Update Date: 03/02/2022
Certification Date: 03/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1321 COLLEGE ST STE E
WOODLAND CA
95695-4706
US

IV. Provider business mailing address

1321 COLLEGE ST STE E
WOODLAND CA
95695-4706
US

V. Phone/Fax

Practice location:
  • Phone: 530-668-1010
  • Fax: 530-668-9799
Mailing address:
  • Phone: 530-668-1010
  • Fax: 530-668-9799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number23245
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number23245
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: