Healthcare Provider Details

I. General information

NPI: 1336845213
Provider Name (Legal Business Name): KATHRYN BARRY MSOT, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2023
Last Update Date: 02/02/2023
Certification Date: 02/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91-2301 OLD FT WEAVER RD
EWA BEACH HI
96706-3602
US

IV. Provider business mailing address

PO BOX 700845
KAPOLEI HI
96709-0845
US

V. Phone/Fax

Practice location:
  • Phone: 808-436-7903
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT-2275-0
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number14187
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code225XM0800X
TaxonomyMental Health Occupational Therapist
License NumberOT-2275-0
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: