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General NPI Number Information
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NPI Number | 1871978452
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Entity Type | Individual
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Provider Name | KENNETH DANIEL KAESTNER COTA/L
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Gender | Male
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Dates
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Enumeration Date | 07/24/2015
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Last Update Date | 07/24/2015
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Provider Practice Location Address
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Address Line | 2315 STOCKTON BLVD
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City | SACRAMENTO
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State | CA
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Zip | 95817-2201
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Country | US
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Telephone | 916-734-7043
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Fax |
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Provider Business Mailing Address
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Address Line | 1808 2ND AVE
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City | SACRAMENTO
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State | CA
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Zip | 95818-2427
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Country | US
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Telephone | 916-616-4619
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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 | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 3087
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License Number State | CA
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