Healthcare Provider Details

I. General information

NPI: 1194924845
Provider Name (Legal Business Name): JAMES PATRICK FOSTER JAMES FOSTER, OTR/L
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2007
Last Update Date: 09/02/2022
Certification Date: 08/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15-1612 3RD AVE
KEA'AU HI
96749-0000
US

IV. Provider business mailing address

HC 2 BOX 9605
KEAAU HI
96749-9332
US

V. Phone/Fax

Practice location:
  • Phone: 808-557-6674
  • Fax: 808-966-9224
Mailing address:
  • Phone: 808-557-6674
  • Fax: 808-966-9224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberOT-517
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: