Healthcare Provider Details

I. General information

NPI: 1124313572
Provider Name (Legal Business Name): MS. LISA KOU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2011
Last Update Date: 06/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1635 S CENTER ST
SANTA ANA CA
92704-4111
US

IV. Provider business mailing address

1635 S CENTER ST
SANTA ANA CA
92704-4111
US

V. Phone/Fax

Practice location:
  • Phone: 714-430-6206
  • Fax:
Mailing address:
  • Phone: 714-430-6206
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: