Provider Demographics
NPI:1174870463
Name:KAWAGUCHI, LISA M (OT)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:KAWAGUCHI
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 ENSUENO W
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92620-1845
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15775 LAGUNA CANYON RD
Practice Address - Street 2:STE 110
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3189
Practice Address - Country:US
Practice Address - Phone:858-792-3460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-06
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7397OtherLICENSE