Provider Demographics
NPI:1144410648
Name:JEFFERIES, KATHLEEN MAE (OT)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:MAE
Last Name:JEFFERIES
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3710 S. ROBERTSON BLVD.
Mailing Address - Street 2:#225
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90232-2351
Mailing Address - Country:US
Mailing Address - Phone:310-837-7849
Mailing Address - Fax:310-838-8454
Practice Address - Street 1:3710 S. ROBERTSON BLVD.
Practice Address - Street 2:#225
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90232-2351
Practice Address - Country:US
Practice Address - Phone:310-837-7849
Practice Address - Fax:310-838-8454
Is Sole Proprietor?:No
Enumeration Date:2007-07-31
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9349225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics