Healthcare Provider Details

I. General information

NPI: 1033658968
Provider Name (Legal Business Name): HAWAII HAND & REHABILITATION SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2017
Last Update Date: 02/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94-1030 WAIPIO UKA ST #101
WAIPAHU HI
96797-4084
US

IV. Provider business mailing address

1401 S BERETANIA ST #730
HONOLULU HI
96814-1870
US

V. Phone/Fax

Practice location:
  • Phone: 808-593-2830
  • Fax: 808-593-2840
Mailing address:
  • Phone: 808-593-2830
  • Fax: 808-593-2840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License NumberOT105
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License NumberOT105
License Number StateHI

VIII. Authorized Official

Name: TAMMY LEE K MOMOHARA
Title or Position: MANAGING MEMBER
Credential: OTR/CHT
Phone: 808-593-2830