Healthcare Provider Details

I. General information

NPI: 1962721621
Provider Name (Legal Business Name): DEVIN OTAGAKI DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2010
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 PUNAHOU ST
HONOLULU HI
96826-1027
US

IV. Provider business mailing address

1310 PUNAHOU ST
HONOLULU HI
96826-1027
US

V. Phone/Fax

Practice location:
  • Phone: 808-951-3626
  • Fax:
Mailing address:
  • Phone: 808-951-3626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number34308
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: