Provider Demographics
NPI:1972068096
Name:KAWAGUCHI, LEONIE B (COTA)
Entity Type:Individual
Prefix:MRS
First Name:LEONIE
Middle Name:B
Last Name:KAWAGUCHI
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:LEONIE
Other - Middle Name:B
Other - Last Name:CAPULONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15334 GOODHUE ST
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90604-2320
Mailing Address - Country:US
Mailing Address - Phone:626-378-6140
Mailing Address - Fax:
Practice Address - Street 1:875 N BREA BLVD
Practice Address - Street 2:
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-2606
Practice Address - Country:US
Practice Address - Phone:714-529-6842
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-02
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOTA4744224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant