Provider Demographics
NPI:1265671762
Name:DUTRA-LEY, KASEY
Entity Type:Individual
Prefix:
First Name:KASEY
Middle Name:
Last Name:DUTRA-LEY
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 1:858 MACARTHUR AVENUE
Mailing Address - Street 2:C
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94129
Mailing Address - Country:US
Mailing Address - Phone:774-644-5179
Mailing Address - Fax:
Practice Address - Street 1:3100 NORIEGA ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94122-4046
Practice Address - Country:US
Practice Address - Phone:650-731-5439
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-07
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9331225X00000X
CA10396225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist