Healthcare Provider Details

I. General information

NPI: 1205926953
Provider Name (Legal Business Name): KATHLEEN MARIE LORD OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 09/09/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25467 MEDICAL CENTER DR STE 100
MURRIETA CA
92562-1501
US

IV. Provider business mailing address

25467 MEDICAL CENTER DR STE 100
MURRIETA CA
92562-1501
US

V. Phone/Fax

Practice location:
  • Phone: 951-899-0204
  • Fax:
Mailing address:
  • Phone: 951-899-0204
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number056-004929
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: