Healthcare Provider Details

I. General information

NPI: 1073149860
Provider Name (Legal Business Name): LEIGH ASHBY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2020
Last Update Date: 02/23/2021
Certification Date: 02/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2430B OKA ST
KILAUEA HI
96754-5332
US

IV. Provider business mailing address

2430B OKA ST
KILAUEA HI
96754-5332
US

V. Phone/Fax

Practice location:
  • Phone: 808-828-0030
  • Fax: 808-977-7769
Mailing address:
  • Phone: 808-828-0030
  • Fax: 808-977-7769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMAT-15307
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: