Healthcare Provider Details

I. General information

NPI: 1851950786
Provider Name (Legal Business Name): KEILI NOELANI KEIKO LONGARES OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KEILI GOO OTR/L

II. Dates (important events)

Enumeration Date: 06/13/2019
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 BALDWIN PARK BLVD
BALDWIN PARK CA
91706-5806
US

IV. Provider business mailing address

400 N STEPHANIE ST STE 310
HENDERSON NV
89014-6608
US

V. Phone/Fax

Practice location:
  • Phone: 833-574-2273
  • Fax:
Mailing address:
  • Phone: 702-454-1162
  • Fax: 702-454-8817

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT-27700
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT-3172
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: