Provider Demographics
NPI:1427551175
Name:NUMAMOTO, DANA KELLY (OTR/L)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:KELLY
Last Name:NUMAMOTO
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2108 CAMBRIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-7379
Mailing Address - Country:US
Mailing Address - Phone:310-339-8406
Mailing Address - Fax:
Practice Address - Street 1:6801 PARK TER STE 200
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-1546
Practice Address - Country:US
Practice Address - Phone:310-665-7100
Practice Address - Fax:310-665-7101
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-08
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT18547225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHandGroup - Single Specialty