MEDICARE: JENNIFER OKAMOTO

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	225100000X	Physical Therapist	PT27439	CA

General Provider Information

NPI Number	:	1568516920
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER OKAMOTO

Provider Business Mailing Address
First Line	:	234 S PACIFIC COAST HWY
Second Line	:	#204
City	:	REDONDO BEACH
State	:	CA
Zip	:	90277-3383
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	234 S PACIFIC COAST HWY
Second Line	:	#204
City	:	REDONDO BEACH
State	:	CA
Zip	:	90277-3383
Country	:	US
Telephone Number	:	310-798-9889
Fax Number	:

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

Provider Enumeration Date	:	01/23/2007
Last Update Date	:	03/03/2008

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Directions to “ JENNIFER OKAMOTO ” Practice Location

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