Active NPI
Katherine Michelle Gazelka, OTR/L
- Occupational Therapist
- San Bernardino, CA
National Provider Identifier
1346750866
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 21973
- Practice address
- 1085 Medical Center Dr
San Bernardino, CA 92411-2023 - Phone
- (909) 877-6333
- NPI assigned
- Oct 10, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 21973 | CA | Primary |
| Occupational Therapist | 225X00000X | 105507 | MN |
Addresses
Primary practice location
1085 Medical Center Dr
San Bernardino, CA 92411-2023
Mailing address
30041 Tessier Apt 292
Laguna Niguel, CA 92677-8912
Phone (218) 255-2725
Other practice location 1
200 1st St SW
Rochester, MN 55905
Phone (507) 284-2511
Other practice location 2
30041 Tessier Apt 292
Laguna Niguel, CA 92677-8912
Phone (800) 259-9897
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1346750866 | Medicaid | MN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 21973 | CA | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1507593600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1613088000000",
"number": "1346750866",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "30041 TESSIER APT 292",
"city": "LAGUNA NIGUEL",
"state": "CA",
"postal_code": "926778912",
"telephone_number": "218-255-2725"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1085 MEDICAL CENTER DR",
"city": "SAN BERNARDINO",
"state": "CA",
"postal_code": "924112023",
"telephone_number": "909-877-6333"
}
],
"practiceLocations": [
{
"address_1": "200 1st St SW",
"address_purpose": "LOCATION",
"city": "Rochester",
"state": "MN",
"postal_code": "55905",
"country_code": "US",
"telephone_number": "507-284-2511",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "30041 Tessier Apt 292",
"address_purpose": "LOCATION",
"city": "Laguna Niguel",
"state": "CA",
"postal_code": "926778912",
"country_code": "US",
"telephone_number": "800-259-9897",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "GAZELKA",
"first_name": "KATHERINE",
"middle_name": "MICHELLE",
"credential": "OTR/L",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-10-10",
"last_updated": "2021-02-12",
"certification_date": "2021-02-12",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "CA",
"license": "21973",
"primary": true
},
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "MN",
"license": "105507",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1346750866",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in San Bernardino, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.