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General NPI Number Information
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NPI Number | 1346750866
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Entity Type | Individual
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Provider Name | KATHERINE MICHELLE GAZELKA OTR/L
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Gender | Female
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Dates
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Enumeration Date | 10/10/2017
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Last Update Date | 02/12/2021
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Provider Practice Location Address
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Address Line | 1085 MEDICAL CENTER DR
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City | SAN BERNARDINO
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State | CA
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Zip | 92411-2023
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Country | US
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Telephone | 909-877-6333
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Fax |
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Provider Business Mailing Address
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Address Line | 30041 TESSIER APT 292
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City | LAGUNA NIGUEL
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State | CA
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Zip | 92677-8912
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Country | US
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Telephone | 218-255-2725
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 21973
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 105507
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License Number State | MN
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