Provider Demographics
NPI:1841841129
Name:KLENSHTEYN, KATHRIN
Entity type:Individual
Prefix:
First Name:KATHRIN
Middle Name:
Last Name:KLENSHTEYN
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 1:22128 COVELLO ST
Mailing Address - Street 2:
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91303-1129
Mailing Address - Country:US
Mailing Address - Phone:818-917-7992
Mailing Address - Fax:
Practice Address - Street 1:22128 COVELLO ST
Practice Address - Street 2:
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91303-1129
Practice Address - Country:US
Practice Address - Phone:818-917-7992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-26
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20252225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist