Healthcare Provider Details

I. General information

NPI: 1174170419
Provider Name (Legal Business Name): KELLI BERNA KIKUE KAWAMOTO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2019
Last Update Date: 07/28/2024
Certification Date: 07/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3558 WOODLAWN DR APT A
HONOLULU HI
96822-1494
US

IV. Provider business mailing address

3558 WOODLAWN DR APT A
HONOLULU HI
96822-1494
US

V. Phone/Fax

Practice location:
  • Phone: 808-475-1225
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT-2513
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: