Provider Demographics
NPI:1760638340
Name:KITAUCHI, KAY KEIKO (BS, OT/L)
Entity Type:Individual
Prefix:
First Name:KAY
Middle Name:KEIKO
Last Name:KITAUCHI
Suffix:
Gender:F
Credentials:BS, OT/L
Other - Prefix:
Other - First Name:KAY
Other - Middle Name:KEIKO
Other - Last Name:KITAUCHI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BS, OT/L
Mailing Address - Street 1:40203 ANTIGUA ROSE TER
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-7022
Mailing Address - Country:US
Mailing Address - Phone:510-516-5457
Mailing Address - Fax:
Practice Address - Street 1:40203 ANTIGUA ROSE TER
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-7022
Practice Address - Country:US
Practice Address - Phone:510-516-5457
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-14
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA407225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist