Provider Demographics
NPI:1598093189
Name:KITTER, SALLY (OTR/L)
Entity type:Individual
Prefix:MS
First Name:SALLY
Middle Name:
Last Name:KITTER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 S CATALINA AVE # A
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-5027
Mailing Address - Country:US
Mailing Address - Phone:310-540-4675
Mailing Address - Fax:
Practice Address - Street 1:1405 S CATALINA AVE # A
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-5027
Practice Address - Country:US
Practice Address - Phone:310-540-4675
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-19
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT0004890225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist