MEDICARE: KAYLA ELIZABETH GAN OTR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225XL0004X	Low Vision Occupational Therapist	22959	CA
2	225X00000X	Occupational Therapist	OT22959	CA

General Provider Information

NPI Number	:	1306509260
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYLA ELIZABETH GAN OTR

Provider Business Mailing Address
First Line	:	5767 W CENTURY BLVD STE 400
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-5631
Country	:	US
Telephone Number	:	310-301-8707
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 STEIN PLZ FL 1
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90095-1061
Country	:	US
Telephone Number	:	310-206-9566
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/18/2021
Last Update Date	:	07/18/2023

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