Provider Demographics
NPI:1871040170
Name:LABARTHE, KAITLYN (OT)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:
Last Name:LABARTHE
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 1:1464 CAPRI AVE
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94954-1451
Mailing Address - Country:US
Mailing Address - Phone:415-847-6296
Mailing Address - Fax:
Practice Address - Street 1:1464 CAPRI AVE
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94954-1451
Practice Address - Country:US
Practice Address - Phone:415-847-6296
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-02
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT11392225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist