Provider Demographics
NPI:1003863606
Name:NUSS, KATHRYN S (OT)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:S
Last Name:NUSS
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 1:516 FOREST AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:PACIFIC GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:93950-4277
Mailing Address - Country:US
Mailing Address - Phone:831-373-5857
Mailing Address - Fax:
Practice Address - Street 1:516 FOREST AVE
Practice Address - Street 2:STE 100
Practice Address - City:PACIFIC GROVE
Practice Address - State:CA
Practice Address - Zip Code:93950-4277
Practice Address - Country:US
Practice Address - Phone:415-351-0716
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-28
Last Update Date:2017-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT3236225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist