Basic Information
| Provider Information | |||||||||
| NPI: | 1558785394 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KERKMAN | ||||||||
| FirstName: | MIKAELA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2586 BUTHMANN AVE | ||||||||
| Address2: | |||||||||
| City: | TRACY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953762165 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2098322273 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2586 BUTHMANN AVE | ||||||||
| Address2: | |||||||||
| City: | TRACY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953762165 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2098322273 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/14/2014 | ||||||||
| LastUpdateDate: | 10/22/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 0119008265 | VA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 225X00000X | 160672 | NV | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 225X00000X | 16519 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.