Provider Demographics
NPI:1487697991
Name:CROW, KATHY ROSE (OTR)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:ROSE
Last Name:CROW
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:KATHY
Other - Middle Name:BURBANK
Other - Last Name:CROW
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR
Mailing Address - Street 1:2059 CASTELLEJA CT
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-5609
Mailing Address - Country:US
Mailing Address - Phone:916-489-3532
Mailing Address - Fax:
Practice Address - Street 1:2059 CASTELLEJA CT
Practice Address - Street 2:
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-5609
Practice Address - Country:US
Practice Address - Phone:916-489-3532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3249225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist