Healthcare Provider Details

I. General information

NPI: 1205070323
Provider Name (Legal Business Name): DARRYL TAD TANAKA OTR/L
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2009
Last Update Date: 04/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12051 CHAUCER RD
LOS ALAMITOS CA
90720-4531
US

IV. Provider business mailing address

12051 CHAUCER RD
LOS ALAMITOS CA
90720-4531
US

V. Phone/Fax

Practice location:
  • Phone: 562-596-3668
  • Fax:
Mailing address:
  • Phone: 562-596-3668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XE0001X
TaxonomyEnvironmental Modification Occupational Therapist
License NumberOT 6588
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: