Healthcare Provider Details

I. General information

NPI: 1235418922
Provider Name (Legal Business Name): KAUAI IN-HOME THERAPY PLUS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2011
Last Update Date: 08/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 PAPALOA RD APT 205
KAPAA HI
96746-1426
US

IV. Provider business mailing address

PO BOX 1714
KAPAA HI
96746-5714
US

V. Phone/Fax

Practice location:
  • Phone: 808-652-1954
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License NumberOT-293
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberOT-293
License Number StateHI

VIII. Authorized Official

Name: ARLENE H. BAKER
Title or Position: CF
Credential:
Phone: 808-652-1954