Healthcare Provider Details

I. General information

NPI: 1083075014
Provider Name (Legal Business Name): OHANA PACIFIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2016
Last Update Date: 03/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 NORTHWEST AVE
BELLINGHAM WA
98225-2300
US

IV. Provider business mailing address

2701 NORTHWEST AVE
BELLINGHAM WA
98225-2300
US

V. Phone/Fax

Practice location:
  • Phone: 360-715-8722
  • Fax:
Mailing address:
  • Phone: 360-715-8722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA60626987
License Number StateWA

VIII. Authorized Official

Name: KAYLA MCINTYRE
Title or Position: MASSAGE THERAPIST
Credential: LMP
Phone: 360-715-8722