Provider Demographics
NPI:1245201722
Name:SHIROMA, DEBRA M (OTR)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:M
Last Name:SHIROMA
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 W 155TH ST
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90247-4213
Mailing Address - Country:US
Mailing Address - Phone:310-768-8337
Mailing Address - Fax:310-768-8337
Practice Address - Street 1:808 W 155TH ST
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90247-4213
Practice Address - Country:US
Practice Address - Phone:310-768-8337
Practice Address - Fax:310-768-8337
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1719225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics