Provider Demographics
NPI:1356120190
Name:STANN, KAMRYN (OTR/L)
Entity type:Individual
Prefix:
First Name:KAMRYN
Middle Name:
Last Name:STANN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35008 PALA TEMECULA RD # 470
Mailing Address - Street 2:
Mailing Address - City:PALA
Mailing Address - State:CA
Mailing Address - Zip Code:92059-2419
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:37111 PALA TEMECULA RD.
Practice Address - Street 2:
Practice Address - City:PALA
Practice Address - State:CA
Practice Address - Zip Code:92059
Practice Address - Country:US
Practice Address - Phone:760-638-9668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-21
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25592225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics