Provider Demographics
NPI:1396926267
Name:PITTMAN, KATHLEEN M (OTR)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:M
Last Name:PITTMAN
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 1:3831 HUGHES AVE
Mailing Address - Street 2:506
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90232-2751
Mailing Address - Country:US
Mailing Address - Phone:310-280-9670
Mailing Address - Fax:310-280-9675
Practice Address - Street 1:3831 HUGHES AVE
Practice Address - Street 2:506
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90232-2751
Practice Address - Country:US
Practice Address - Phone:310-280-9670
Practice Address - Fax:310-280-9675
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-20
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT838225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOT838OtherLICENSE