Healthcare Provider Details

I. General information

NPI: 1881898799
Provider Name (Legal Business Name): EUNICE Y PARK OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: EUNICE Y LEE

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 11/11/2024
Certification Date: 11/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95-1059 MAHEA ST
MILILANI HI
96789-6593
US

IV. Provider business mailing address

95-1059 MAHEA ST
MILILANI HI
96789-6593
US

V. Phone/Fax

Practice location:
  • Phone: 323-236-2221
  • Fax:
Mailing address:
  • Phone: 323-236-2221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XF0002X
TaxonomyFeeding, Eating & Swallowing Occupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: