Basic Information
| Provider Information | |||||||||
| NPI: | 1932773777 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | PRIMEAU | ||||||||
| FirstName: | CASEY | ||||||||
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| Credential: | OTD, OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 469 S LEXINGTON DR | ||||||||
| Address2: | |||||||||
| City: | FOLSOM | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956306507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5109678523 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3498 GREEN VALLEY RD | ||||||||
| Address2: | |||||||||
| City: | RESCUE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956729625 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5303918670 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2021 | ||||||||
| LastUpdateDate: | 05/17/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 20600 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.