Individual
JASON KAKUZO ICHIMARU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OTR/L
Contact information
Practice address
39650 LIBERTY ST, FREMONT, CA 94538-2223
(510) 498-3900
Mailing address
325 DISTEL CIR, LOS ALTOS, CA 94022-1408
(510) 498-3900
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
18145
CBOT
CA
01
—
392634
NBCOT
—
Enumeration date
12/26/2017
Last updated
01/20/2022
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