Healthcare Provider Details

I. General information

NPI: 1255253134
Provider Name (Legal Business Name): JOSHUA FONTAINE OTD, OTR/L
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 KEOLU DR
KAILUA HI
96734-4149
US

IV. Provider business mailing address

4168 PUU PANINI AVE # 2
HONOLULU HI
96816-4737
US

V. Phone/Fax

Practice location:
  • Phone: 808-260-9056
  • Fax:
Mailing address:
  • Phone: 808-493-4916
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2745
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number2745
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: