Healthcare Provider Details

I. General information

NPI: 1417296906
Provider Name (Legal Business Name): ELLEN CHITOSE OKAZAKI LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2013
Last Update Date: 02/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 KAINEHE ST SUITE 207
KAILUA HI
96734-2670
US

IV. Provider business mailing address

PO BOX 6318 KANEOHE
KANEOHE HI
96744-9172
US

V. Phone/Fax

Practice location:
  • Phone: 808-389-0532
  • Fax:
Mailing address:
  • Phone: 808-389-0532
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number12624
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: