Provider Demographics
NPI:1265880942
Name:VISTA OT
Entity type:Organization
Organization Name:VISTA OT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:EIRI
Authorized Official - Middle Name:HAYASHIGATANI
Authorized Official - Last Name:INENAGA
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LOT
Authorized Official - Phone:408-306-0954
Mailing Address - Street 1:261 VISTA VERDE WAY
Mailing Address - Street 2:
Mailing Address - City:PORTOLA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94028-8149
Mailing Address - Country:US
Mailing Address - Phone:408-306-0954
Mailing Address - Fax:
Practice Address - Street 1:261 VISTA VERDE WAY
Practice Address - Street 2:
Practice Address - City:PORTOLA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94028-8149
Practice Address - Country:US
Practice Address - Phone:408-306-0954
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-02
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1151251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health