Healthcare Provider Details

I. General information

NPI: 1538311402
Provider Name (Legal Business Name): JASON TSE OTD, OTR/L
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/22/2008
Last Update Date: 11/01/2024
Certification Date: 10/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28-2815 HAWAII BELT RD
PEPEEKEO HI
96783-9678
US

IV. Provider business mailing address

PO BOX 831080
PEPEEKEO HI
96783-1071
US

V. Phone/Fax

Practice location:
  • Phone: 626-536-4519
  • Fax:
Mailing address:
  • Phone: 626-536-4519
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License NumberOT 10152
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT-2466
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: