Provider Demographics
NPI:1972992154
Name:KEARLEY, THU LY (COTA)
Entity type:Individual
Prefix:MRS
First Name:THU
Middle Name:LY
Last Name:KEARLEY
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3739 DUFFY WAY
Mailing Address - Street 2:
Mailing Address - City:BONITA
Mailing Address - State:CA
Mailing Address - Zip Code:91902-1026
Mailing Address - Country:US
Mailing Address - Phone:619-739-3726
Mailing Address - Fax:
Practice Address - Street 1:3739 DUFFY WAY
Practice Address - Street 2:
Practice Address - City:BONITA
Practice Address - State:CA
Practice Address - Zip Code:91902-1026
Practice Address - Country:US
Practice Address - Phone:619-739-3726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-12
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOTA 2693224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant