Provider Demographics
NPI:1073125233
Name:DUNIVIN, KARA A (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:KARA
Middle Name:A
Last Name:DUNIVIN
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3565 OAKLEAF CT
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91977-2841
Mailing Address - Country:US
Mailing Address - Phone:858-243-7009
Mailing Address - Fax:
Practice Address - Street 1:11 KING CHARLES DR STE A2
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:RI
Practice Address - Zip Code:02871-1364
Practice Address - Country:US
Practice Address - Phone:401-683-8063
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-19
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA659224Z00000X
RIOTA00077224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant