Healthcare Provider Details

I. General information

NPI: 1538392501
Provider Name (Legal Business Name): ASHLEY HARUKA NAKATSUKA OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2009
Last Update Date: 07/28/2020
Certification Date: 07/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 WILHELMINA RISE
HONOLULU HI
96816-3287
US

IV. Provider business mailing address

1210 WILHELMINA RISE
HONOLULU HI
96816-3287
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number864
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: