Provider Demographics
NPI:1053976472
Name:YOSHIMIZU, TRACY MICHIKO (OTD, OTR/L)
Entity type:Individual
Prefix:DR
First Name:TRACY
Middle Name:MICHIKO
Last Name:YOSHIMIZU
Suffix:
Gender:F
Credentials:OTD, 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:PO BOX 6094
Mailing Address - Street 2:
Mailing Address - City:KAHULUI
Mailing Address - State:HI
Mailing Address - Zip Code:96733-6094
Mailing Address - Country:US
Mailing Address - Phone:626-818-8783
Mailing Address - Fax:
Practice Address - Street 1:335 HOOHANA ST STE F
Practice Address - Street 2:
Practice Address - City:KAHULUI
Practice Address - State:HI
Practice Address - Zip Code:96732-3527
Practice Address - Country:US
Practice Address - Phone:707-347-9456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-01
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIOT-2052225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist