Healthcare Provider Details

I. General information

NPI: 1578980371
Provider Name (Legal Business Name): THERAPY ON THE GO, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2014
Last Update Date: 03/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66-216 FARRINGTON HIGHWAY 201
WAIALUA HI
96791
US

IV. Provider business mailing address

66-932 KUEWA DR
WAIALUA HI
96791-9719
US

V. Phone/Fax

Practice location:
  • Phone: 808-342-0534
  • Fax:
Mailing address:
  • Phone: 808-342-0534
  • Fax: 808-637-2000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number386
License Number StateHI

VIII. Authorized Official

Name: SHELLEY BOLING
Title or Position: OCCUPATIONAL THERAPIST
Credential:
Phone: 808-342-0534