Provider Demographics
NPI:1992378574
Name:OMOKAWA, KEITO (AUD)
Entity Type:Individual
Prefix:
First Name:KEITO
Middle Name:
Last Name:OMOKAWA
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 E THOMAS ST UPPR
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98112-5122
Mailing Address - Country:US
Mailing Address - Phone:425-346-4573
Mailing Address - Fax:
Practice Address - Street 1:1625 19TH AVE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-2848
Practice Address - Country:US
Practice Address - Phone:206-323-5770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-21
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist