Healthcare Provider Details

I. General information

NPI: 1306602800
Provider Name (Legal Business Name): KONNOR JAMES MCINTIRE MSOT, OTR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2024
Last Update Date: 06/19/2024
Certification Date: 06/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94-1181 KA UKA BLVD STE C
WAIPAHU HI
96797-4485
US

IV. Provider business mailing address

239 E CENTER ST
LINDON UT
84042-2023
US

V. Phone/Fax

Practice location:
  • Phone: 808-260-9056
  • Fax:
Mailing address:
  • Phone: 801-301-3030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT-2483
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT-2483
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: