Provider Demographics
NPI:1386152098
Name:GOMEZ, KATHRYNA MONTAYRE (MAOT, OTR/L)
Entity type:Individual
Prefix:
First Name:KATHRYNA
Middle Name:MONTAYRE
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:MAOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12045 KESWICK ST APT 302
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91605-3060
Mailing Address - Country:US
Mailing Address - Phone:929-434-0090
Mailing Address - Fax:
Practice Address - Street 1:20501 VENTURA BLVD
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-2337
Practice Address - Country:US
Practice Address - Phone:818-343-3900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-16
Last Update Date:2018-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT17955225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist