Provider Demographics
NPI:1861541658
Name:HENEHAN, KAREN MAURINE (OTR, CHT)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:MAURINE
Last Name:HENEHAN
Suffix:
Gender:F
Credentials:OTR, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:767 15TH AVE
Mailing Address - Street 2:
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-1945
Mailing Address - Country:US
Mailing Address - Phone:650-269-7870
Mailing Address - Fax:
Practice Address - Street 1:1450 VETERANS BLVD STE 110
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94063
Practice Address - Country:US
Practice Address - Phone:650-839-1800
Practice Address - Fax:650-839-1818
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2021-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT2284225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ022852Medicare ID - Type UnspecifiedOT PROVIDER #