Provider Demographics
NPI:1356451298
Name:NISHIMURA, KAREN (OT)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:NISHIMURA
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7760 EL CAMINO REAL
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92009-8553
Mailing Address - Country:US
Mailing Address - Phone:760-634-9750
Mailing Address - Fax:760-634-9752
Practice Address - Street 1:7760 EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92009-8553
Practice Address - Country:US
Practice Address - Phone:760-634-9750
Practice Address - Fax:760-634-9752
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT6467174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOT6467OtherOT LICENSE #
CAOT6467OtherOT LICENSE #
CAWOT6467DMedicare ID - Type Unspecified
CAWOT6467FMedicare ID - Type Unspecified
CAWOT6467EMedicare ID - Type Unspecified