Provider Demographics
NPI:1033497508
Name:DE CASTRO JACQUES, KAREN LYNN (OTR)
Entity Type:Individual
Prefix:
First Name:KAREN LYNN
Middle Name:
Last Name:DE CASTRO JACQUES
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:KAREN LYNN
Other - Middle Name:B
Other - Last Name:DE CASTRO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1245 OAK STREET
Mailing Address - Street 2:#1
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94117
Mailing Address - Country:US
Mailing Address - Phone:408-823-1457
Mailing Address - Fax:
Practice Address - Street 1:1245 OAK STREET
Practice Address - Street 2:#1
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94117
Practice Address - Country:US
Practice Address - Phone:408-823-1457
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-01
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT10545225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist