Jason Kakuzo Ichimaru, OTR/L

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

Practice address

39650 Liberty St
Fremont, CA 94538-2223

Phone

(510) 498-3900

NPI assigned

Dec 26, 2017

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Schoenstein Physical Therapy and Worker Selection Testing Inc.

  • Physical Therapist
  • Redwood City, CA
  • NPI 1174618573
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1514246400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1642636800000",
    "number": "1922514124",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "325 DISTEL CIR",
            "city": "LOS ALTOS",
            "state": "CA",
            "postal_code": "940221408",
            "telephone_number": "510-498-3900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "39650 LIBERTY ST",
            "city": "FREMONT",
            "state": "CA",
            "postal_code": "945382223",
            "telephone_number": "510-498-3900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ICHIMARU",
        "first_name": "JASON",
        "middle_name": "KAKUZO",
        "credential": "OTR/L",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-12-26",
        "last_updated": "2022-01-20",
        "certification_date": "2022-01-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CBOT",
            "identifier": "18145",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NBCOT",
            "identifier": "392634",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Monica Ibarra
• Omar Ibarra
• Xytlali Ibarra
• Sahar Ibrahim, PA
• Brandon Nelson Icban
• Erik Iem, AMFT
• Ikaika Health, Inc.
• Sheri Lyn Ikea
• Jarrod Joseph Ildesa, LAC.
• Hira Ilyas, OTR/L

• Occupational Therapist in Fremont, CA
• Providers in Fremont, CA by specialty
• Occupational Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.