Healthcare Provider Details

I. General information

NPI: 1952953721
Provider Name (Legal Business Name): ASHLEY ODY BCBA, LBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2019
Last Update Date: 11/10/2022
Certification Date: 07/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94-450 MOKUOLA ST STE 100
WAIPAHU HI
96797-3388
US

IV. Provider business mailing address

427 ALA MAKANI ST STE 200
KAHULUI HI
96732-3507
US

V. Phone/Fax

Practice location:
  • Phone: 808-244-6879
  • Fax:
Mailing address:
  • Phone: 808-244-6879
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBA-654-0
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: