Provider Demographics
NPI:1619339009
Name:SHIMODA, JAMES (OTR/L)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:SHIMODA
Suffix:
Gender:M
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 1:388 KNIGHT WAY
Mailing Address - Street 2:
Mailing Address - City:LA CANADA
Mailing Address - State:CA
Mailing Address - Zip Code:91011-2721
Mailing Address - Country:US
Mailing Address - Phone:818-217-9155
Mailing Address - Fax:
Practice Address - Street 1:7700 ORANGETHORPE AVE STE 3
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90621-3453
Practice Address - Country:US
Practice Address - Phone:714-670-0007
Practice Address - Fax:714-670-0005
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-24
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA342595225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist