Healthcare Provider Details

I. General information

NPI: 1013519255
Provider Name (Legal Business Name): KATHERINE OLMEDO OTD, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/12/2020
Last Update Date: 11/12/2020
Certification Date: 11/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19045 PORTOLA DR STE B
SALINAS CA
93908-1204
US

IV. Provider business mailing address

6721 NAOMI AVE
BUENA PARK CA
90620-1644
US

V. Phone/Fax

Practice location:
  • Phone: 831-455-8901
  • Fax:
Mailing address:
  • Phone: 909-260-4746
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: