Healthcare Provider Details

I. General information

NPI: 1588539365
Provider Name (Legal Business Name): OPEN GROUNDS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2025
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13160 MINDANAO WAY STE 211
MARINA DEL REY CA
90292-7942
US

IV. Provider business mailing address

13160 MINDANAO WAY STE 211
MARINA DEL REY CA
90292-7942
US

V. Phone/Fax

Practice location:
  • Phone: 310-437-0932
  • Fax: 844-688-0141
Mailing address:
  • Phone: 310-437-0932
  • Fax: 844-688-0141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XM0800X
TaxonomyMental Health Occupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: MRS. SHAUNNA KOTKA
Title or Position: CEO
Credential: OTD, OTR/L, CLT-LANA
Phone: 310-437-0932