MEDICARE: SHAUNNA KOTKA OTD, OTR/L, CLT-LANA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225XP0019X	Physical Rehabilitation Occupational Therapist	28299	CA
2	225XM0800X	Mental Health Occupational Therapist	28299	CA
3	225XN1300X	Neurorehabilitation Occupational Therapist	28299	CA
4	225700000X	Massage Therapist		CA

General Provider Information

NPI Number	:	1043038847
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAUNNA KOTKA OTD, OTR/L, CLT-LANA

Provider Business Mailing Address
First Line	:	234 S PACIFIC COAST HWY STE 205
Second Line	:
City	:	REDONDO BEACH
State	:	CA
Zip	:	90277-7036
Country	:	US
Telephone Number	:	310-882-0177
Fax Number	:	844-688-0141

Provider Business Practice Location Address
First Line	:	234 S PACIFIC COAST HWY STE 205
Second Line	:
City	:	REDONDO BEACH
State	:	CA
Zip	:	90277-7036
Country	:	US
Telephone Number	:	310-882-0177
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/30/2024
Last Update Date	:	05/11/2026

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Directions to “ SHAUNNA KOTKA OTD, OTR/L, CLT-LANA” Practice Location

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