Healthcare Provider Details

I. General information

NPI: 1184382020
Provider Name (Legal Business Name): KATIE DAHLERBRUCH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2021
Last Update Date: 06/20/2022
Certification Date: 06/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11840 S LA CIENEGA BLVD
HAWTHORNE CA
90250-3459
US

IV. Provider business mailing address

5452 MANITOWAC DR
RANCHO PALOS VERDES CA
90275-2327
US

V. Phone/Fax

Practice location:
  • Phone: 424-269-3400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: