Healthcare Provider Details

I. General information

NPI: 1851192868
Provider Name (Legal Business Name): OLIVIA KOTTER MT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2025
Last Update Date: 03/24/2025
Certification Date: 03/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 DAIRY RD STE 239
KAHULUI HI
96732
US

IV. Provider business mailing address

213 HOOULU LN APT 1106
WAILUKU HI
96793-4103
US

V. Phone/Fax

Practice location:
  • Phone: 808-667-6161
  • Fax:
Mailing address:
  • Phone: 808-268-9017
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMAT-18026
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: