Healthcare Provider Details

I. General information

NPI: 1144227091
Provider Name (Legal Business Name): NICOLE CARDILLO OT/CHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 04/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95-390 KUAHELANI AVE 1C
MILILANI HI
96789-1192
US

IV. Provider business mailing address

91-1654 BURKE ST
EWA BEACH HI
96706-2049
US

V. Phone/Fax

Practice location:
  • Phone: 808-445-4428
  • Fax: 806-637-9592
Mailing address:
  • Phone: 808-285-5457
  • Fax: 757-321-3332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number0119003304
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: