Healthcare Provider Details

I. General information

NPI: 1457859258
Provider Name (Legal Business Name): KATHRYN MARIE GILSON OTR/L, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KATHRYN PETERSON

II. Dates (important events)

Enumeration Date: 01/26/2018
Last Update Date: 04/07/2025
Certification Date: 04/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

166 GEARY ST. STE 1500 #2152
SAN FRANCISCO CA
94108-5628
US

IV. Provider business mailing address

166 GEARY ST. STE 1500 #2152
SAN FRANCISCO CA
94108-5628
US

V. Phone/Fax

Practice location:
  • Phone: 818-319-2742
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number15570
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL-317029
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: