Healthcare Provider Details

I. General information

NPI: 1972812477
Provider Name (Legal Business Name): MICHAEL LUCIAN WOJCIECHOWSKI OTR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2010
Last Update Date: 09/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 KAPALAIA PL
WAILUKU HI
96793-2165
US

IV. Provider business mailing address

43 KAPALAIA PL
WAILUKU HI
96793-2165
US

V. Phone/Fax

Practice location:
  • Phone: 808-385-4049
  • Fax:
Mailing address:
  • Phone: 808-385-4049
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number267
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: