Provider Demographics
NPI:1891269833
Name:MILO, KATHRYN DIANE (OTR)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:DIANE
Last Name:MILO
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2336 MINUTEMAN WAY
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-6531
Mailing Address - Country:US
Mailing Address - Phone:714-743-5284
Mailing Address - Fax:
Practice Address - Street 1:2336 MINUTEMAN WAY
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-6531
Practice Address - Country:US
Practice Address - Phone:714-743-5284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-13
Last Update Date:2019-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT17281225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist