Provider Demographics
NPI:1275840316
Name:NORDERUM, KARA LYNN
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:LYNN
Last Name:NORDERUM
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 1:1766 CALIFORNIA ST
Mailing Address - Street 2:PO BOX 991173
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-1905
Mailing Address - Country:US
Mailing Address - Phone:530-242-1511
Mailing Address - Fax:530-242-1611
Practice Address - Street 1:1766 CALIFORNIA ST
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-1905
Practice Address - Country:US
Practice Address - Phone:530-242-1511
Practice Address - Fax:530-242-1611
Is Sole Proprietor?:No
Enumeration Date:2010-09-10
Last Update Date:2010-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOTA 1712224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant