=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265564710
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DR. ELAYNE MOLINE KLASSON
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/11/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 951 BLANCO CIR STE B
-----------------------------------------------------
City | SALINAS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93901-4451
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 831-784-2157
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 403 BELLA VISTA AVE
-----------------------------------------------------
City | LOS GATOS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95032-5421
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-356-5609
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225XH1300X
-----------------------------------------------------
Taxonomy Name | Human Factors Occupational Therapist
-----------------------------------------------------
License Number | OT 8150
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------