Healthcare Provider Details

I. General information

NPI: 1336810076
Provider Name (Legal Business Name): KATHERINE KAATZ OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2021
Last Update Date: 09/22/2021
Certification Date: 09/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10431 COMMERCE ST STE A
REDLANDS CA
92374-0110
US

IV. Provider business mailing address

10431 COMMERCE ST STE A
REDLANDS CA
92374-0110
US

V. Phone/Fax

Practice location:
  • Phone: 909-735-7654
  • Fax: 909-342-6411
Mailing address:
  • Phone: 909-735-7654
  • Fax: 909-342-6411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number439477
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: