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General NPI Number Information
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NPI Number | 1700175908
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Entity Type | Organization
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Legal Business Name | KAISER FOUNDATION REHABILITATION CENTER
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Dates
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Enumeration Date | 03/29/2011
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Last Update Date | 03/29/2011
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Provider Practice Location Address
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Address Line | 975 SERENO DR
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City | VALLEJO
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State | CA
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Zip | 94589-2441
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Country | US
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Telephone | 707-651-4784
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Fax | 707-651-2308
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Provider Business Mailing Address
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Address Line | 975 SERENO DR
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City | VALLEJO
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State | CA
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Zip | 94589-2441
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Country | US
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Telephone | 707-651-4784
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Fax | 707-651-2308
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Authorized Official
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Title or Position | SPEECH LANGUAGE PATHOLOGIST
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Name | KATIE MARIE SCHONEMAN
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Credential | MS
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Telephone | 707-651-4784
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 283X00000X
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Taxonomy Name | Rehabilitation Hospital
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License Number | 18786
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License Number State | CA
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