Healthcare Provider Details

I. General information

NPI: 1467365171
Provider Name (Legal Business Name): MOME'S ISLAND TOUCH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

TEDI OF SAMOA
FAGATOGO AS
96799
US

IV. Provider business mailing address

PO BOX 3618
PAGO PAGO AS
96799-3618
US

V. Phone/Fax

Practice location:
  • Phone: 684-782-3642
  • Fax:
Mailing address:
  • Phone: 684-782-3642
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: LENE MAIAVA
Title or Position: CEO
Credential:
Phone: 684-782-3642