Provider Demographics
NPI:1750679106
Name:MAULDIN, DAVID KRAFT (COTA)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:KRAFT
Last Name:MAULDIN
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 BOISE
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-1907
Mailing Address - Country:US
Mailing Address - Phone:949-929-4036
Mailing Address - Fax:
Practice Address - Street 1:9 BOISE
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-1907
Practice Address - Country:US
Practice Address - Phone:949-929-4036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-19
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOTA 1209225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist