Provider Demographics
NPI:1083310817
Name:SACRAMENTO, KRISTEN (MOT)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:SACRAMENTO
Suffix:
Gender:F
Credentials:MOT
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:
Other - Last Name:BUGINAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:500 TAMAL PLZ STE 505
Mailing Address - Street 2:
Mailing Address - City:CORTE MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:94925-1184
Mailing Address - Country:US
Mailing Address - Phone:415-531-3027
Mailing Address - Fax:
Practice Address - Street 1:500 TAMAL PLZ STE 505
Practice Address - Street 2:
Practice Address - City:CORTE MADERA
Practice Address - State:CA
Practice Address - Zip Code:94925-1184
Practice Address - Country:US
Practice Address - Phone:415-531-3027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-02
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225X00000X
CA23865225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist