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General NPI Number Information
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NPI Number | 1265880942
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Entity Type | Organization
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Legal Business Name | VISTA OT
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Dates
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Enumeration Date | 06/02/2016
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Last Update Date | 06/02/2016
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Provider Practice Location Address
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Address Line | 261 VISTA VERDE WAY
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City | PORTOLA VALLEY
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State | CA
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Zip | 94028-8149
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Country | US
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Telephone | 408-306-0954
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Fax |
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Provider Business Mailing Address
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Address Line | 261 VISTA VERDE WAY
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City | PORTOLA VALLEY
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State | CA
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Zip | 94028-8149
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Country | US
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Telephone | 408-306-0954
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Fax |
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Authorized Official
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Title or Position | OCCUPATIONAL THERAPIST
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Name | MRS. EIRI HAYASHIGATANI INENAGA
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Credential | MS, LOT
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Telephone | 408-306-0954
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 1151
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License Number State | CA
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