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General NPI Number Information
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NPI Number | 1245316983
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Entity Type | Individual
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Provider Name | WILLOW DEA OT
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Gender | Female
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Dates
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Enumeration Date | 10/27/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2685 MARINE WAY SUITE 1411
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City | MOUNTAIN VIEW
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State | CA
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Zip | 94040-1119
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Country | US
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Telephone | 650-279-1084
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Fax |
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Provider Business Mailing Address
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Address Line | 1 BAYWOOD AVE 7
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City | SAN MATEO
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State | CA
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Zip | 94402-1537
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Country | US
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Telephone | 650-344-6961
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Fax | 650-344-6604
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OTCA3473
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License Number State | CA
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