Healthcare Provider Details

I. General information

NPI: 1417191446
Provider Name (Legal Business Name): KATHRYN GRACE HAAS OTD, OTR/L, ATAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHRYN GRACE DESIMONE OTR/L

II. Dates (important events)

Enumeration Date: 04/21/2009
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18072 CLEARWATER CIR
HUNTINGTON BEACH CA
92648-1119
US

IV. Provider business mailing address

18072 CLEARWATER CIR
HUNTINGTON BEACH CA
92648-1119
US

V. Phone/Fax

Practice location:
  • Phone: 907-570-1164
  • Fax:
Mailing address:
  • Phone: 907-570-1116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number9600
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number1499
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: