Provider Demographics
NPI:1609409127
Name:ISHIKAWA, JANE NOYURI (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:JANE
Middle Name:NOYURI
Last Name:ISHIKAWA
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 1:6907 SHAWNEE MISSION PKWY
Mailing Address - Street 2:SUITE #207
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66202
Mailing Address - Country:US
Mailing Address - Phone:888-913-1910
Mailing Address - Fax:877-913-1174
Practice Address - Street 1:6907 SHAWNEE MISSION PKWY
Practice Address - Street 2:SUITE #207
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66202
Practice Address - Country:US
Practice Address - Phone:888-913-1910
Practice Address - Fax:877-913-1174
Is Sole Proprietor?:No
Enumeration Date:2020-02-13
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS17-03676225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist