Provider Demographics
NPI:1265817597
Name:KATHRYN A. HAVIS-FALER
Entity Type:Organization
Organization Name:KATHRYN A. HAVIS-FALER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:A
Authorized Official - Last Name:HAVIS-FALER
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:916-835-2002
Mailing Address - Street 1:1720 MOROCCO DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95125-5823
Mailing Address - Country:US
Mailing Address - Phone:408-439-3305
Mailing Address - Fax:
Practice Address - Street 1:1990 FRUITDALE AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-2709
Practice Address - Country:US
Practice Address - Phone:408-998-8447
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-28
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3724251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care