Provider Demographics
NPI:1265564710
Name:KLASSON, ELAYNE MOLINE
Entity type:Individual
Prefix:DR
First Name:ELAYNE
Middle Name:MOLINE
Last Name:KLASSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 BELLA VISTA AVE
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-5421
Mailing Address - Country:US
Mailing Address - Phone:408-356-5609
Mailing Address - Fax:
Practice Address - Street 1:951 BLANCO CIR STE B
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-4451
Practice Address - Country:US
Practice Address - Phone:831-784-2157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT 8150225XH1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHuman Factors