Healthcare Provider Details

I. General information

NPI: 1164727913
Provider Name (Legal Business Name): KERRIE ANN CAISON BAGG OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2011
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 NEWPORT AVENUE
LONG BEACH CA
90803
US

IV. Provider business mailing address

250 NEWPORT AVENUE
LONG BEACH CA
90803
US

V. Phone/Fax

Practice location:
  • Phone: 562-573-7141
  • Fax:
Mailing address:
  • Phone: 562-573-7141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number29137
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: