Basic Information
| Provider Information | |||||||||
| NPI: | 1811388499 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SANDERS | ||||||||
| FirstName: | KATHRYN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5962 LA PLACE CT | ||||||||
| Address2: | #170 | ||||||||
| City: | CARLSBAD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920088807 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 2888 LONG BEACH BLVD | ||||||||
| Address2: | SUITE 405 | ||||||||
| City: | LONG BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 908061530 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5625954489 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/18/2015 | ||||||||
| LastUpdateDate: | 02/18/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | 1008 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.