Healthcare Provider Details

I. General information

NPI: 1447187604
Provider Name (Legal Business Name): CAITLIN VERONICA KRAUSE OTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 SAN PABLO ST
LOS ANGELES CA
90033-5313
US

IV. Provider business mailing address

2408 S SHENANDOAH ST
LOS ANGELES CA
90034-2000
US

V. Phone/Fax

Practice location:
  • Phone: 800-872-2273
  • Fax:
Mailing address:
  • Phone: 505-440-3081
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number3817
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: