Provider Demographics
NPI:1134462500
Name:GATES, KERRIE JANE (MS OTR/L)
Entity Type:Individual
Prefix:
First Name:KERRIE
Middle Name:JANE
Last Name:GATES
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:468 OGLE ST
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-3244
Mailing Address - Country:US
Mailing Address - Phone:949-378-4794
Mailing Address - Fax:
Practice Address - Street 1:11105 KNOTT AVE STE A
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:CA
Practice Address - Zip Code:90630-5137
Practice Address - Country:US
Practice Address - Phone:714-893-7399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-03
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12200225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics