Provider Demographics
NPI:1568626687
Name:ALLEN, KATHERINE EDNA (OTD, OTR/L)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:EDNA
Last Name:ALLEN
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2711 KENNEY DR
Mailing Address - Street 2:
Mailing Address - City:SAN PABLO
Mailing Address - State:CA
Mailing Address - Zip Code:94806-1515
Mailing Address - Country:US
Mailing Address - Phone:510-439-8048
Mailing Address - Fax:
Practice Address - Street 1:2711 KENNEY DR
Practice Address - Street 2:
Practice Address - City:SAN PABLO
Practice Address - State:CA
Practice Address - Zip Code:94806-1515
Practice Address - Country:US
Practice Address - Phone:510-439-8048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-17
Last Update Date:2015-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CAOT 8916225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health