Healthcare Provider Details

I. General information

NPI: 1255652236
Provider Name (Legal Business Name): OT TO YOU LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2010
Last Update Date: 06/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2957 KALAKAUA AVE APT 201
HONOLULU HI
96815-4650
US

IV. Provider business mailing address

PO BOX 4559
HONOLULU HI
96812-4559
US

V. Phone/Fax

Practice location:
  • Phone: 808-347-1969
  • Fax: 808-440-0395
Mailing address:
  • Phone: 808-347-1969
  • Fax: 808-440-0395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT-764
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. HILARY LEE HABERSHAW
Title or Position: OTR
Credential:
Phone: 808-347-1969