=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386027274
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KAREN DELA SANTA-PURA MS OTR/L
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/09/2015
-----------------------------------------------------
Last Update Date | 01/24/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8917 97TH ST
-----------------------------------------------------
City | WOODHAVEN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11421-2725
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-415-5558
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8917 97TH ST
-----------------------------------------------------
City | WOODHAVEN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11421-2725
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-415-5558
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 018171
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 15051
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------