Provider Demographics
NPI:1093930711
Name:VIOLA-PRESS, KATHLEEN SUE
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:SUE
Last Name:VIOLA-PRESS
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:PO BOX 123
Mailing Address - Street 2:
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91376-0123
Mailing Address - Country:US
Mailing Address - Phone:818-512-2505
Mailing Address - Fax:805-373-1922
Practice Address - Street 1:399 ERBES RD
Practice Address - Street 2:SUITE 26
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91362-2740
Practice Address - Country:US
Practice Address - Phone:818-512-2505
Practice Address - Fax:805-373-1922
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3938225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist