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General NPI Number Information
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NPI Number | 1265671762
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Entity Type | Individual
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Provider Name | KASEY DUTRA-LEY
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Gender | Female
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Dates
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Enumeration Date | 02/07/2009
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Last Update Date | 10/26/2021
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Provider Practice Location Address
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Address Line | 3100 NORIEGA ST
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City | SAN FRANCISCO
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State | CA
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Zip | 94122-4046
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Country | US
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Telephone | 650-731-5439
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Fax |
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Provider Business Mailing Address
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Address Line | 858 MACARTHUR AVENUE C
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City | SAN FRANCISCO
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State | CA
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Zip | 94129
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Country | US
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Telephone | 774-644-5179
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Fax |
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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 | 9331
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 10396
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License Number State | CA
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