=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487211140
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KAREN KOVAC NORMAN OTR/L
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/28/2019
-----------------------------------------------------
Last Update Date | 05/28/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 ROWLAND WAY STE 205
-----------------------------------------------------
City | NOVATO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94945-5041
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-492-4870
-----------------------------------------------------
Fax | 415-492-4871
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2350 W EL CAMINO REAL FL 2
-----------------------------------------------------
City | MOUNTAIN VIEW
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94040-6203
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 650-845-7649
-----------------------------------------------------
Fax | 650-942-9312
-----------------------------------------------------
=====================================================
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 | 2542
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225XP0200X
-----------------------------------------------------
Taxonomy Name | Pediatric Occupational Therapist
-----------------------------------------------------
License Number | 2542
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------