Healthcare Provider Details

I. General information

NPI: 1750706933
Provider Name (Legal Business Name): TIMOTHY NASH O.T
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/25/2014
Last Update Date: 02/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 WILHELMINA RISE UNIT B
HONOLULU HI
96816-3287
US

IV. Provider business mailing address

1210 WILHELMINA RISE UNIT B
HONOLULU HI
96816-3287
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT-621
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: