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General NPI Number Information
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NPI Number | 1164169017
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Entity Type | Individual
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Provider Name | LATOYA SHAW
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Gender | Female
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Dates
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Enumeration Date | 05/12/2022
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Last Update Date | 05/12/2022
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Provider Practice Location Address
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Address Line | 459 PATTERSON RD
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City | HONOLULU
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State | HI
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Zip | 96819-1522
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Country | US
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Telephone | 808-433-0293
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Fax |
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Provider Business Mailing Address
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Address Line | 249 KAPILI ST APT 601B
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City | HONOLULU
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State | HI
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Zip | 96815-3172
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Country | US
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Telephone | 267-997-4933
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225800000X
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Taxonomy Name | Recreation Therapist
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License Number | 65565
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License Number State | PA
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