Provider Demographics
NPI:1871247429
Name:BRANDARIZ, KARYNA MELISSA (OTD, OTR/L)
Entity Type:Individual
Prefix:
First Name:KARYNA
Middle Name:MELISSA
Last Name:BRANDARIZ
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 1:4984 WESTMONT AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95130-2258
Mailing Address - Country:US
Mailing Address - Phone:408-806-5956
Mailing Address - Fax:
Practice Address - Street 1:1290 LAWRENCE STATION RD
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94089-2220
Practice Address - Country:US
Practice Address - Phone:408-743-5332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-11
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT23007225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist