Healthcare Provider Details

I. General information

NPI: 1104566967
Provider Name (Legal Business Name): DIANE VICKI SEARLES MASSAGE THERAPIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2022
Last Update Date: 03/30/2022
Certification Date: 03/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

465 HINANO ST
HILO HI
96720-4406
US

IV. Provider business mailing address

PO BOX 103
HONOMU HI
96728-0103
US

V. Phone/Fax

Practice location:
  • Phone: 808-769-0171
  • Fax:
Mailing address:
  • Phone: 808-769-0171
  • 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:
Title or Position:
Credential:
Phone: