Provider Demographics
NPI:1174063275
Name:MIZOKAWA, JILL (MOTR/L)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:MIZOKAWA
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 KIRBY DR APT B516
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77098-1486
Mailing Address - Country:US
Mailing Address - Phone:808-371-3730
Mailing Address - Fax:
Practice Address - Street 1:2800 KIRBY DR APT B516
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77098-1486
Practice Address - Country:US
Practice Address - Phone:808-371-3730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-08
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT60547817225XP0200X
TX121722225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics