Healthcare Provider Details

I. General information

NPI: 1801936034
Provider Name (Legal Business Name): STEPHANIE MEI LIN OBATAKE R.P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 12/07/2021
Certification Date: 12/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 FARRINGTON HWY
KAPOLEI HI
96707-2001
US

IV. Provider business mailing address

45-438 NAKULUAI ST
KANEOHE HI
96744
US

V. Phone/Fax

Practice location:
  • Phone: 808-674-9262
  • Fax:
Mailing address:
  • Phone: 808-386-3429
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT-782
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: