Healthcare Provider Details

I. General information

NPI: 1316634546
Provider Name (Legal Business Name): ASHLIE REESE RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2023
Last Update Date: 04/18/2023
Certification Date: 04/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4510 SALT LAKE BLVD
HONOLULU HI
96818-3153
US

IV. Provider business mailing address

4510 SALT LAKE BLVD STE C4
HONOLULU HI
96818-3171
US

V. Phone/Fax

Practice location:
  • Phone: 808-486-1804
  • Fax:
Mailing address:
  • Phone: 808-486-1804
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: