Provider Demographics
NPI:1912482712
Name:GRODIN, LENA LERNER (MED, MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:LENA
Middle Name:LERNER
Last Name:GRODIN
Suffix:
Gender:F
Credentials:MED, MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 PEARL AVE
Mailing Address - Street 2:
Mailing Address - City:SAN CARLOS
Mailing Address - State:CA
Mailing Address - Zip Code:94070-4667
Mailing Address - Country:US
Mailing Address - Phone:650-394-5521
Mailing Address - Fax:
Practice Address - Street 1:300 PEARL AVE
Practice Address - Street 2:
Practice Address - City:SAN CARLOS
Practice Address - State:CA
Practice Address - Zip Code:94070-4667
Practice Address - Country:US
Practice Address - Phone:650-394-5521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-27
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17224225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics