Healthcare Provider Details

I. General information

NPI: 1245201722
Provider Name (Legal Business Name): DEBRA M. SHIROMA OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

808 W 155TH ST
GARDENA CA
90247-4213
US

IV. Provider business mailing address

808 W 155TH ST
GARDENA CA
90247-4213
US

V. Phone/Fax

Practice location:
  • Phone: 310-768-8337
  • Fax: 310-768-8337
Mailing address:
  • Phone: 310-768-8337
  • Fax: 310-768-8337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number1719
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: