Active NPI
Dorothy Enomoto, BS
- Occupational Therapist
- Antioch, CA
National Provider Identifier
1639670292
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- Practice address
- 4001 Lone Tree Way
Antioch, CA 94509-6232 - Phone
- (925) 754-0470
- NPI assigned
- Feb 27, 2018
- Reactivated
- Jan 19, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | 11725084 | CA | |
| Behavior Technician | 106S00000X | CA | ||
| Occupational Therapist | 225X00000X | Primary |
Addresses
Primary practice location
4001 Lone Tree Way
Antioch, CA 94509-6232
Mailing address
4560 SE International Way Ste 100
Milwaukie, OR 97222-4628
Other practice location 1
424 Peninsula Ave
San Mateo, CA 94401-1653
Phone (650) 286-4396
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Bachelor of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11725084 | CA | MD | Behavioral Analyst |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1519689600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1675468800000",
"number": "1639670292",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4560 SE INTERNATIONAL WAY STE 100",
"city": "MILWAUKIE",
"state": "OR",
"postal_code": "972224628"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4001 LONE TREE WAY",
"city": "ANTIOCH",
"state": "CA",
"postal_code": "945096232",
"telephone_number": "925-754-0470"
}
],
"practiceLocations": [
{
"address_1": "424 Peninsula Ave",
"address_purpose": "LOCATION",
"city": "San Mateo",
"state": "CA",
"postal_code": "944011653",
"country_code": "US",
"telephone_number": "650-286-4396",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "ENOMOTO",
"first_name": "DOROTHY",
"credential": "BS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-02-27",
"last_updated": "2023-02-04",
"certification_date": "2023-02-04",
"deactivation_date": "2022-12-01",
"reactivation_date": "2023-01-19",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "CA",
"license": "11725084",
"primary": false
},
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "CA",
"license": null,
"primary": false
},
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Antioch, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.