Provider Demographics
NPI:1811416027
Name:DESAUTELS, KENYA (CPO)
Entity Type:Individual
Prefix:
First Name:KENYA
Middle Name:
Last Name:DESAUTELS
Suffix:
Gender:F
Credentials:CPO
Other - Prefix:
Other - First Name:KENYA
Other - Middle Name:
Other - Last Name:SANDHAGEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CO
Mailing Address - Street 1:1411 SECRET RAVINE PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-6042
Mailing Address - Country:US
Mailing Address - Phone:916-784-6900
Mailing Address - Fax:916-784-6901
Practice Address - Street 1:1411 SECRET RAVINE PKWY STE 100
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-6042
Practice Address - Country:US
Practice Address - Phone:916-784-6900
Practice Address - Fax:916-784-6901
Is Sole Proprietor?:No
Enumeration Date:2017-09-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist