Healthcare Provider Details

I. General information

NPI: 1821481029
Provider Name (Legal Business Name): MASARU OKAJIMA MS, MOT, OTR/L
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2015
Last Update Date: 03/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3030 WEBSTER ST
OAKLAND CA
94609-3411
US

IV. Provider business mailing address

4821 FAIR AVE
OAKLAND CA
94619-2930
US

V. Phone/Fax

Practice location:
  • Phone: 510-451-9792
  • Fax:
Mailing address:
  • Phone: 510-206-2896
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number15044
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: