MEDICARE: KTMS, INC.

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	252Y00000X	Early Intervention Provider Agency
2	252Y00000X	Early Intervention Provider Agency	OT11359	CA

General Provider Information

NPI Number	:	1285047217
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KTMS, INC.

Provider Business Mailing Address
First Line	:	10137 BRIDLEVALE DR
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90064-4611
Country	:	US
Telephone Number	:	310-365-0500
Fax Number	:

Provider Business Practice Location Address
First Line	:	10137 BRIDLEVALE DR
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90064-4611
Country	:	US
Telephone Number	:	310-365-0500
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MS. LISA J PERLSON
Credential	:	OTD, OTR/L
Telephone Number	:	310-365-0500

Provider Enumeration Date	:	06/06/2014
Last Update Date	:	03/21/2022

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