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General NPI Number Information
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NPI Number | 1639781842
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Entity Type | Individual
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Provider Name | KATHLEEN KANEGAWA
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Gender | Female
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Dates
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Enumeration Date | 08/19/2020
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Last Update Date | 08/19/2020
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Provider Practice Location Address
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Address Line | 31248 OAK CREST DR STE 120
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City | WESTLAKE VILLAGE
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State | CA
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Zip | 91361-5673
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Country | US
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Telephone | 818-538-5880
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Fax |
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Provider Business Mailing Address
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Address Line | 955 N DUESENBERG DR APT 2310
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City | ONTARIO
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State | CA
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Zip | 91764-7920
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Country | US
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Telephone | 909-993-4928
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 21329
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License Number State | CA
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