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NPI Code Detail

MEDICARE: ASHLEY KEIKO MAK OTD, OTR/L

MEDICARE: ASHLEY KEIKO MAK OTD, OTR/L
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225XM0800XMental Health Occupational Therapist23330CA

General Provider Information

NPI Number : 1447808506
Entity Type Code : Individual
Provider Name (Legal Business Name) : ASHLEY KEIKO MAK OTD, OTR/L
Provider Business Mailing Address
First Line : 4211 AVALON BLVD
Second Line :
City : LOS ANGELES
State : CA
Zip : 90011-5622
Country : US
Telephone Number : 323-233-0425
Fax Number :
Provider Business Practice Location Address
First Line : 4211 AVALON BLVD
Second Line :
City : LOS ANGELES
State : CA
Zip : 90011-5622
Country : US
Telephone Number : 323-233-0425
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/30/2019
Last Update Date : 06/16/2026

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