Provider Demographics
NPI:1063702231
Name:THALWITZ, DORA MARIE
Entity type:Individual
Prefix:
First Name:DORA
Middle Name:MARIE
Last Name:THALWITZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:644 MENLO AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-4745
Mailing Address - Country:US
Mailing Address - Phone:650-752-6346
Mailing Address - Fax:
Practice Address - Street 1:644 MENLO AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-4745
Practice Address - Country:US
Practice Address - Phone:650-752-6346
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-08
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10591225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist