MEDICARE: JASON TSE 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
1	225XP0019X	Physical Rehabilitation Occupational Therapist	OT 10152	CA
2	225X00000X	Occupational Therapist	OT-2466	HI

General Provider Information

NPI Number	:	1538311402
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON TSE OTD, OTR/L

Provider Business Mailing Address
First Line	:	PO BOX 831080
Second Line	:
City	:	PEPEEKEO
State	:	HI
Zip	:	96783-1071
Country	:	US
Telephone Number	:	626-536-4519
Fax Number	:

Provider Business Practice Location Address
First Line	:	28-2815 HAWAII BELT RD
Second Line	:
City	:	PEPEEKEO
State	:	HI
Zip	:	96783-9678
Country	:	US
Telephone Number	:	626-536-4519
Fax Number	:

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

Provider Enumeration Date	:	10/22/2008
Last Update Date	:	11/01/2024

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