Healthcare Provider Details

I. General information

NPI: 1326555624
Provider Name (Legal Business Name): KATIE WILLEBRANDS OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2018
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date: 09/29/2018
Reactivation Date: 03/24/2023

III. Provider practice location address

10780 CA-2 #405
LOS ANGELES CA
90025
US

IV. Provider business mailing address

1300 N 17TH AVE
GREELEY CO
80631-9584
US

V. Phone/Fax

Practice location:
  • Phone: 310-234-0300
  • Fax:
Mailing address:
  • Phone: 970-347-2120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number24616
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: