Provider Demographics
NPI:1922159029
Name:COLE, KATHLEEN DIANE (OT)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:DIANE
Last Name:COLE
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 1:26409 FAIRGATE AVE
Mailing Address - Street 2:
Mailing Address - City:NEWHALL
Mailing Address - State:CA
Mailing Address - Zip Code:91321-2208
Mailing Address - Country:US
Mailing Address - Phone:661-252-7618
Mailing Address - Fax:
Practice Address - Street 1:26409 FAIRGATE AVE
Practice Address - Street 2:
Practice Address - City:NEWHALL
Practice Address - State:CA
Practice Address - Zip Code:91321-2208
Practice Address - Country:US
Practice Address - Phone:661-252-7618
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT 2461225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACMS169422OtherOT PEDS