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General NPI Number Information
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NPI Number | 1003136433
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Entity Type | Organization
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Legal Business Name | MAUI CENTER FOR CHILD DEVELOPMENT, INC.
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Dates
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Enumeration Date | 06/08/2010
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Last Update Date | 06/08/2010
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Provider Practice Location Address
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Address Line | 244 PAPA PL SUITE 102
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City | KAHULUI
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State | HI
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Zip | 96732-2988
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Country | US
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Telephone | 808-873-7700
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Fax | 808-873-7710
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Provider Business Mailing Address
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Address Line | PO BOX 1379
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City | PUUNENE
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State | HI
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Zip | 96784-1379
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Country | US
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Telephone | 808-873-7700
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Fax | 808-873-7710
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. DAWN K BLAKE
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Credential | O.T.
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Telephone | 808-873-7700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | 222
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License Number State | HI
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