Provider Demographics
NPI:1043038847
Name:KOTKA, SHAUNNA KALEEN
Entity type:Individual
Prefix:
First Name:SHAUNNA
Middle Name:KALEEN
Last Name:KOTKA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 S PACIFIC COAST HWY STE 205
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-7036
Mailing Address - Country:US
Mailing Address - Phone:310-882-0177
Mailing Address - Fax:
Practice Address - Street 1:234 S PACIFIC COAST HWY STE 205
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-7036
Practice Address - Country:US
Practice Address - Phone:310-882-0177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-30
Last Update Date:2025-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist