MEDICARE: LIANE Y. K. OTAKE I

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	OT-399	HI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	OT-399	OTHER	HI	STATE OT LICENSE

General Provider Information

NPI Number	:	1487776936
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LIANE Y. K. OTAKE I

Provider Business Mailing Address
First Line	:	200 N VINEYARD BLVD # B261
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96817-3950
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 N VINEYARD BLVD # B261
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96817-3950
Country	:	US
Telephone Number	:	808-483-4906
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/04/2007
Last Update Date	:	08/07/2023

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Directions to “ LIANE Y. K. OTAKE I ” Practice Location

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