Provider Demographics
NPI:1538670773
Name:KOTSEVA, KALINA (MSCA, OTR/L)
Entity Type:Individual
Prefix:
First Name:KALINA
Middle Name:
Last Name:KOTSEVA
Suffix:
Gender:F
Credentials:MSCA, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 SANTA LUCIA AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:SAN BRUNO
Mailing Address - State:CA
Mailing Address - Zip Code:94066-5223
Mailing Address - Country:US
Mailing Address - Phone:415-653-2990
Mailing Address - Fax:
Practice Address - Street 1:1335 SAN CARLOS AVE STE A
Practice Address - Street 2:
Practice Address - City:SAN CARLOS
Practice Address - State:CA
Practice Address - Zip Code:94070-5604
Practice Address - Country:US
Practice Address - Phone:650-592-1819
Practice Address - Fax:650-592-1819
Is Sole Proprietor?:No
Enumeration Date:2017-10-16
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16618225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA16618OtherCBOT