Healthcare Provider Details

I. General information

NPI: 1205274099
Provider Name (Legal Business Name): MARY PATRICIA CULLIGAN OTR/L, SWC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2013
Last Update Date: 01/10/2024
Certification Date: 01/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

335 HOOHANA ST STE F
KAHULUI HI
96732-3527
US

IV. Provider business mailing address

335 HOOHANA ST STE F
KAHULUI HI
96732-3527
US

V. Phone/Fax

Practice location:
  • Phone: 760-473-7881
  • Fax:
Mailing address:
  • Phone: 808-446-2032
  • Fax: 833-565-3144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XF0002X
TaxonomyFeeding, Eating & Swallowing Occupational Therapist
License Number970
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT-2290
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: