Healthcare Provider Details

I. General information

NPI: 1699248922
Provider Name (Legal Business Name): REENA TAKAMURA OTD, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2019
Last Update Date: 08/12/2025
Certification Date: 08/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3350 W 1ST ST
LOS ANGELES CA
90004-6000
US

IV. Provider business mailing address

3667 MENTONE AVE APT 9
LOS ANGELES CA
90034-4228
US

V. Phone/Fax

Practice location:
  • Phone: 808-351-0048
  • Fax:
Mailing address:
  • Phone: 808-351-0048
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT19508
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: