Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Tyler Ichiki, OTR/L

Individual provider Hand Occupational Therapist · NPI 1902625825

Tyler Ichiki, OTR/L is an Occupational Therapist in Private Practice in Gresham, Oregon. Qualified in 2023, 3 years ago. Practices with Sportscare Physical Therapy @ Cornell, LLC, a 35-clinician group and accepts Medicare assignment. Licensed in Oregon.

Years since qualifying
3
Licensed in
OR
In the registry since
2024
What do these letters mean?
OTR/L — Occupational Therapist, Registered and Licensed
An occupational therapist who is both nationally registered and state licensed.

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Practice location Address checks out

24076 SE Stark St Ste 210
Gresham, OR 97030-3376
Phone: (503) 491-1666
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Hand Occupational Therapist (primary) Taxonomy 225XH1200X · Licence 505784 (OR)

Record details

NPI number1902625825
Entity typeIndividual (Type 1)
GenderMale
Credentials OTR/L
Sole proprietorNo
NPI enumeratedOctober 8, 2024
Last updated in NPPESOctober 8, 2024
Certification dateOctober 8, 2024

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyOCCUPATIONAL THERAPIST IN PRIVATE PRACTICE
Medical schoolOTHER
Graduated 2023 (3 years in practice)
Group practice Sportscare Physical Therapy @ Cornell, Llc — 35 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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