Provider Demographics
NPI:1932756509
Name:GOTHELF, KAYLEE ELIZABETH CARNEY
Entity Type:Individual
Prefix:
First Name:KAYLEE
Middle Name:ELIZABETH CARNEY
Last Name:GOTHELF
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 1:1940 FRANKLIN ST APT 104
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109-3471
Mailing Address - Country:US
Mailing Address - Phone:408-472-6505
Mailing Address - Fax:
Practice Address - Street 1:1625 OAK PARK BLVD
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-4487
Practice Address - Country:US
Practice Address - Phone:925-935-5222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-19
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist