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General NPI Number Information
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NPI Number | 1669006649
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Entity Type | Individual
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Provider Name | KRISTIN DANIELLE MITZENMACHER OTR/L, MS
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Gender | Female
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Dates
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Enumeration Date | 02/27/2020
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Last Update Date | 02/27/2020
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Provider Practice Location Address
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Address Line | 2909A CARLETON ST
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City | SAN DIEGO
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State | CA
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Zip | 92106-2713
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Country | US
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Telephone | 619-795-7790
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Fax |
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Provider Business Mailing Address
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Address Line | 5175 ANDREW JACKSON ST
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City | OCEANSIDE
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State | CA
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Zip | 92057-4404
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Country | US
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Telephone | 909-260-4931
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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 | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | 20957
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License Number State | CA
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