Healthcare Provider Details

I. General information

NPI: 1154986453
Provider Name (Legal Business Name): AMY OKURA LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2019
Last Update Date: 05/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2070 KILAUEA AVE
HILO HI
96720-5233
US

IV. Provider business mailing address

2070 KILAUEA AVE
HILO HI
96720-5233
US

V. Phone/Fax

Practice location:
  • Phone: 808-959-4588
  • Fax:
Mailing address:
  • Phone: 808-959-4588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number6155
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: