Provider Demographics
NPI:1538364674
Name:MIKAMI, LYNN CHIYEKO (OTR)
Entity type:Individual
Prefix:MS
First Name:LYNN
Middle Name:CHIYEKO
Last Name:MIKAMI
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2160 W 235TH PL
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90501-6046
Mailing Address - Country:US
Mailing Address - Phone:310-326-2174
Mailing Address - Fax:
Practice Address - Street 1:KAISER PERMANENTE SOUTH BAY MEDICAL CENTER OT DEPT
Practice Address - Street 2:25975 S. NORMANDIE AVENUE
Practice Address - City:HARBOR CITY
Practice Address - State:CA
Practice Address - Zip Code:90710
Practice Address - Country:US
Practice Address - Phone:310-517-6404
Practice Address - Fax:310-517-6295
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT 1103174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist