Healthcare Provider Details

I. General information

NPI: 1043534381
Provider Name (Legal Business Name): CHARLOTTE U KENNEDY OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHARLOTTE C UNEMORI

II. Dates (important events)

Enumeration Date: 03/15/2010
Last Update Date: 11/19/2020
Certification Date: 11/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 S KIHEI RD STE 102
KIHEI HI
96753-8145
US

IV. Provider business mailing address

1325 S KIHEI RD STE 102
KIHEI HI
96753-8145
US

V. Phone/Fax

Practice location:
  • Phone: 907-622-6363
  • Fax: 907-622-6366
Mailing address:
  • Phone: 808-269-1720
  • Fax: 866-431-9522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT-518
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: