=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992954614
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NOELANI TANOUYE OTR/L
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/17/2008
-----------------------------------------------------
Last Update Date | 09/17/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6400 LAUREL CANYON BLVD
-----------------------------------------------------
City | N HOLLYWOOD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91606-1571
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-763-0136
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2500 ABBOT KINNEY BLVD APT. #23
-----------------------------------------------------
City | VENICE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90291-4791
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-979-4765
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | OT10215
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------