Healthcare Provider Details

I. General information

NPI: 1386409472
Provider Name (Legal Business Name): RACHEL WILSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/16/2024
Last Update Date: 06/02/2025
Certification Date: 06/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

459 PATTERSON RD
HONOLULU HI
96819-1522
US

IV. Provider business mailing address

459 PATTERSON RD
HONOLULU HI
96819-1522
US

V. Phone/Fax

Practice location:
  • Phone: 808-852-9278
  • Fax:
Mailing address:
  • Phone: 808-852-9278
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number83058
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: