Healthcare Provider Details

I. General information

NPI: 1083961361
Provider Name (Legal Business Name): KATHLEEN MARIE BARBARO M.A. OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2012
Last Update Date: 08/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E DEL MAR BLVD SUITE 112
PASADENA CA
91105-2544
US

IV. Provider business mailing address

2001 POLARIS DR
GLENDALE CA
91208-2426
US

V. Phone/Fax

Practice location:
  • Phone: 626-564-2700
  • Fax: 626-564-2770
Mailing address:
  • Phone: 818-802-6648
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number12816
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: