Provider Demographics
NPI:1639663529
Name:NOTO, KENNETH GREGORY (OTR/L)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:GREGORY
Last Name:NOTO
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:670 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95062-2703
Mailing Address - Country:US
Mailing Address - Phone:908-839-2743
Mailing Address - Fax:
Practice Address - Street 1:670 7TH AVE
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95062-2703
Practice Address - Country:US
Practice Address - Phone:908-839-2743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-14
Last Update Date:2018-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00686900225X00000X
CA15852225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist