Provider Demographics
NPI:1184279663
Name:IZUMIHARA, KAY AKIKO (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:KAY
Middle Name:AKIKO
Last Name:IZUMIHARA
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 1:1212 NUUANU AVE APT 803
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-4024
Mailing Address - Country:US
Mailing Address - Phone:562-541-6065
Mailing Address - Fax:
Practice Address - Street 1:1174 WAIMANO HOME RD
Practice Address - Street 2:
Practice Address - City:PEARL CITY
Practice Address - State:HI
Practice Address - Zip Code:96782-2674
Practice Address - Country:US
Practice Address - Phone:808-456-8090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-02
Last Update Date:2019-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1893225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty