Provider Demographics
NPI:1942496864
Name:SOVYAK, PATRICE (OTR/L)
Entity Type:Individual
Prefix:
First Name:PATRICE
Middle Name:
Last Name:SOVYAK
Suffix:
Gender:F
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 1:303 POTRERO ST., STE. 42-103
Mailing Address - Street 2:FRONT ST., INC
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060
Mailing Address - Country:US
Mailing Address - Phone:831-466-9307
Mailing Address - Fax:831-466-9748
Practice Address - Street 1:303 POTRERO ST STE 42-103
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-2779
Practice Address - Country:US
Practice Address - Phone:831-466-9307
Practice Address - Fax:831-466-9748
Is Sole Proprietor?:No
Enumeration Date:2007-09-25
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT 3321101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOT 3321OtherOCCUPATIONAL THERAPIST