Provider Demographics
NPI:1457859258
Name:GILSON, KATHRYN MARIE (OTR/L, IBCLC)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:MARIE
Last Name:GILSON
Suffix:
Gender:
Credentials:OTR/L, IBCLC
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:
Other - Last Name:PETERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:166 GEARY ST.
Mailing Address - Street 2:STE 1500 #2152
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94108-5628
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:166 GEARY ST.
Practice Address - Street 2:STE 1500 #2152
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94108-5628
Practice Address - Country:US
Practice Address - Phone:818-319-2742
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-26
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
L-317029174N00000X
CA15570225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No174N00000XOther Service ProvidersLactation Consultant, Non-RN
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA15570OtherCALIFORNIA BOARD OF OCCUPATIONAL THERAPY
L-317029OtherINTERNATIONAL BOARD OF LACTATION CONSULTANT EXAMINERS