Healthcare Provider Details

I. General information

NPI: 1356701759
Provider Name (Legal Business Name): SANDRA WATAOKA OTR, CDRS, CDI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2016
Last Update Date: 02/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

826 S KING ST
HONOLULU HI
96813-3009
US

IV. Provider business mailing address

826 S KING ST
HONOLULU HI
96813-3009
US

V. Phone/Fax

Practice location:
  • Phone: 808-523-9043
  • Fax: 808-526-0673
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224ZE0001X
TaxonomyEnvironmental Modification Occupational Therapy Assistant
License Number001
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number001
License Number StateHI
# 3
Primary TaxonomyN
Taxonomy Code225XE1200X
TaxonomyErgonomics Occupational Therapist
License Number001
License Number StateHI
# 4
Primary TaxonomyN
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License Number001
License Number StateHI
# 5
Primary TaxonomyN
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License Number001
License Number StateHI
# 6
Primary TaxonomyN
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number001
License Number StateHI
# 7
Primary TaxonomyN
Taxonomy Code225XR0403X
TaxonomyDriving and Community Mobility Occupational Therapist
License Number001
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: