Provider Demographics
NPI:1093044034
Name:PITBLADDO, KAREN D
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:D
Last Name:PITBLADDO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 8TH AVE STE 207
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-3057
Mailing Address - Country:US
Mailing Address - Phone:415-831-4263
Mailing Address - Fax:
Practice Address - Street 1:402 8TH AVE STE 207
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-3057
Practice Address - Country:US
Practice Address - Phone:415-831-4263
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-22
Last Update Date:2009-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT5064225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOT5064OtherLICENSE