MEDICARE: MRS. AILEEN DIANE KOMAI OT

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
1	225XH1200X	Hand Occupational Therapist	OT4052	CA

General Provider Information

NPI Number	:	1487793675
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AILEEN DIANE KOMAI OT

Provider Business Mailing Address
First Line	:	4225 CANDLEBERRY AVE
Second Line	:
City	:	SEAL BEACH
State	:	CA
Zip	:	90740-2824
Country	:	US
Telephone Number	:	562-594-8132
Fax Number	:

Provider Business Practice Location Address
First Line	:	2920 WESTMINSTER AVE
Second Line	:
City	:	SEAL BEACH
State	:	CA
Zip	:	90740-5305
Country	:	US
Telephone Number	:	562-594-8600
Fax Number	:	562-594-4599

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/05/2007
Last Update Date	:	07/08/2007

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