1942496864 NPI number — PATRICE SOVYAK OTR/L

Table of content: PATRICE SOVYAK OTR/L (NPI 1942496864)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942496864 NPI number — PATRICE SOVYAK OTR/L

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SOVYAK
Provider First Name:
PATRICE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OTR/L
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1942496864
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/18/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
303 POTRERO ST., STE. 42-103
Provider Second Line Business Mailing Address:
FRONT ST., INC
Provider Business Mailing Address City Name:
SANTA CRUZ
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95060
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
831-466-9307
Provider Business Mailing Address Fax Number:
831-466-9748

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
303 POTRERO ST STE 42-103
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANTA CRUZ
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95060-2779
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
831-466-9307
Provider Business Practice Location Address Fax Number:
831-466-9748
Provider Enumeration Date:
09/25/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  OT 3321 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: OT 3321 . This is a "OCCUPATIONAL THERAPIST" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".