MEDICARE: KATELYN ROSE GULLATT OTR

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	225X00000X	Occupational Therapist	19142	CA

General Provider Information

NPI Number	:	1548829435
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATELYN ROSE GULLATT OTR

Provider Business Mailing Address
First Line	:	606 LION ST
Second Line	:
City	:	OJAI
State	:	CA
Zip	:	93023-2714
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1565 HILL RD
Second Line	:
City	:	NOVATO
State	:	CA
Zip	:	94947-4063
Country	:	US
Telephone Number	:	415-897-6161
Fax Number	:

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

Provider Enumeration Date	:	06/13/2019
Last Update Date	:	06/13/2019

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