Provider Demographics
NPI:1720781255
Name:HISAYASU, KAILA AKEMI (CTRS, MOT, OTR/L)
Entity Type:Individual
Prefix:
First Name:KAILA
Middle Name:AKEMI
Last Name:HISAYASU
Suffix:
Gender:F
Credentials:CTRS, MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20136 MAPES AVE
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-6564
Mailing Address - Country:US
Mailing Address - Phone:562-308-6465
Mailing Address - Fax:
Practice Address - Street 1:7300 W SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90046-3429
Practice Address - Country:US
Practice Address - Phone:323-285-2283
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-23
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24795225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist