Healthcare Provider Details

I. General information

NPI: 1962331538
Provider Name (Legal Business Name): KATHLEEN LEMOS OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4620 VALLECITO ST
SHASTA LAKE CA
96019-9348
US

IV. Provider business mailing address

1242 DIAMOND BAR CT
REDDING CA
96003-2194
US

V. Phone/Fax

Practice location:
  • Phone: 530-275-7020
  • Fax:
Mailing address:
  • Phone: 530-515-4712
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number1533
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: