Katelyn Fuller

 
 From dcatalyst16 
 18443858095 
 8/29/2022 10:58:59 PDT 
 Page 13 of 17 
 Dr Catherine Stevens MD 
 Today's Date: 07/01/2024
 RehabOne Medical Group, Inc. 
 All Clinics' US Mail Address: 13980 Blossom Hill Road, STE B Los Gatos, CA 96532 
 Industrial Injury Info: 
 D.O.B: 
 21/10/1984 
 Adjuster: Jennifer Restori 
 Claim # 
 00546822824-WC-01 
 Phone # 916-657-6536 
 INJURY DATE: 
 05/05/2017 
 Fax # 
 866-650-0658 
 Insurance: Gallagher Bassett (Corona) 
 Patient Info: 
 Address: 
 46864 Long Springs Suite 738
Jamesview, CA 82980
 Phone (C): 831-650-3659 
 Pref. Lang.: 
 English 
 Diagnosis: 
 M65.17 
 Intervertebral disc disorders with radiculopathy, lumbosacral region 
 Case Type: 
 Work Compensation 
 176 Katelyn Fuller : Aug 25, 2022 
 page 12 
