Provider Demographics
NPI:1366863508
Name:ITO, EMI (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:EMI
Middle Name:
Last Name:ITO
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 1:1348 SHADOWBROOK TER
Mailing Address - Street 2:
Mailing Address - City:HARBOR CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90710
Mailing Address - Country:US
Mailing Address - Phone:310-706-5782
Mailing Address - Fax:
Practice Address - Street 1:1348 SHADOWBROOK TER
Practice Address - Street 2:
Practice Address - City:HARBOR CITY
Practice Address - State:CA
Practice Address - Zip Code:90710-2472
Practice Address - Country:US
Practice Address - Phone:310-706-5782
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-13
Last Update Date:2013-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT13922225X00000X
CA13922225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA13922OtherCALIFORNIA BOARD OF OCCUPATIONAL THERAPY
CAOT13922OtherCALIFORNIA BOARD OF OCCUPATIONAL THERAPY