MEDICARE: MRS. EVELYN OGAMI-GLARY LMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	7120	HI

General Provider Information

NPI Number	:	1326303181
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. EVELYN OGAMI-GLARY LMT

Provider Business Mailing Address
First Line	:	99-350 AHEAHE STREET
Second Line	:
City	:	AIEA
State	:	HI
Zip	:	96701
Country	:	US
Telephone Number	:	808-253-1498
Fax Number	:	808-487-3014

Provider Business Practice Location Address
First Line	:	1780 BOUGAINVILLEA LP
Second Line	:	PHYSICAL FITNESS CENTER ALIAMANU MILITARY RESERVATION
City	:	HONOLULU
State	:	HI
Zip	:	96818
Country	:	US
Telephone Number	:	808-253-1498
Fax Number	:	808-487-3014

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/09/2012
Last Update Date	:	07/09/2012

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