Healthcare Provider Details

I. General information

NPI: 1639570500
Provider Name (Legal Business Name): CECELIA MARIE BURNS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2014
Last Update Date: 03/06/2024
Certification Date: 03/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4740 LAE RD
KALAHEO HI
96741-9224
US

IV. Provider business mailing address

4740 LAE RD
KALAHEO HI
96741-9224
US

V. Phone/Fax

Practice location:
  • Phone: 808-652-5750
  • Fax:
Mailing address:
  • Phone: 808-652-5750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMAT-8283
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code173C00000X
TaxonomyReflexologist
License Number8283
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: