Provider Demographics
NPI:1629394861
Name:WOOD HUTCHISON, KESTREL SUZANNE (COTA/L)
Entity Type:Individual
Prefix:
First Name:KESTREL
Middle Name:SUZANNE
Last Name:WOOD HUTCHISON
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:KESTREL
Other - Middle Name:SUZANNE
Other - Last Name:WOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA/L
Mailing Address - Street 1:1120 VIA CALLEJON STE B
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-6264
Mailing Address - Country:US
Mailing Address - Phone:949-498-5100
Mailing Address - Fax:949-366-5665
Practice Address - Street 1:1120 VIA CALLEJON STE B
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673-6264
Practice Address - Country:US
Practice Address - Phone:949-498-5100
Practice Address - Fax:949-366-5665
Is Sole Proprietor?:No
Enumeration Date:2010-04-13
Last Update Date:2010-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0TA1912224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant