Healthcare Provider Details

I. General information

NPI: 1073449245
Provider Name (Legal Business Name): KENDALL MASAKO HISAMOTO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15215 S 48TH ST STE 145
PHOENIX AZ
85044-9138
US

IV. Provider business mailing address

15215 S 48TH ST UNIT 145
PHOENIX AZ
85044-9142
US

V. Phone/Fax

Practice location:
  • Phone: 602-358-8148
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA050127
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: