Provider Demographics
NPI:1982748588
Name:BIRCH, IRENE GRACE (MS)
Entity type:Individual
Prefix:
First Name:IRENE
Middle Name:GRACE
Last Name:BIRCH
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3020 KERNER BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-5444
Mailing Address - Country:US
Mailing Address - Phone:415-455-8481
Mailing Address - Fax:415-455-8483
Practice Address - Street 1:3020 KERNER BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-5444
Practice Address - Country:US
Practice Address - Phone:415-455-8481
Practice Address - Fax:415-455-8483
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner