Provider Demographics
NPI:1528767043
Name:ADAMETZ, KRISTA (COTA/L)
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:
Last Name:ADAMETZ
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:KRISTA
Other - Middle Name:
Other - Last Name:HAGLUND
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1620 MICHELE WAY
Mailing Address - Street 2:
Mailing Address - City:ESCALON
Mailing Address - State:CA
Mailing Address - Zip Code:95320-9574
Mailing Address - Country:US
Mailing Address - Phone:619-249-3391
Mailing Address - Fax:
Practice Address - Street 1:159 E ORANGEBURG AVE
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-5334
Practice Address - Country:US
Practice Address - Phone:109-525-2811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-23
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1858224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1858OtherCOTA/L