Provider Demographics
NPI:1891269833
Name:GIBSON, KATHRYN DIANE (OTR)
Entity type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:DIANE
Last Name:GIBSON
Suffix:
Gender:
Credentials:OTR
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:DIANE
Other - Last Name:MILO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:19232 HARDING LN
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92646-2024
Mailing Address - Country:US
Mailing Address - Phone:714-743-5284
Mailing Address - Fax:
Practice Address - Street 1:19232 HARDING LN
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92646-2024
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:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT17281225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist