Healthcare Provider Details

I. General information

NPI: 1750592986
Provider Name (Legal Business Name): JILL C TAOSAKA OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99-080 KAUHALE ST STE D9
AIEA HI
96701-4114
US

IV. Provider business mailing address

94-779 KAAKA ST
WAIPAHU HI
96797-1272
US

V. Phone/Fax

Practice location:
  • Phone: 808-483-4917
  • Fax: 808-493-4914
Mailing address:
  • Phone: 808-483-4917
  • Fax: 808-483-4914

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number071
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: