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General NPI Number Information
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NPI Number | 1174170419
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Entity Type | Individual
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Provider Name | KELLI BERNA KIKUE KAWAMOTO
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Gender | Female
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Dates
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Enumeration Date | 08/21/2019
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Last Update Date | 07/28/2024
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Provider Practice Location Address
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Address Line | 3558 WOODLAWN DR APT A
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City | HONOLULU
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State | HI
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Zip | 96822-1494
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Country | US
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Telephone | 808-475-1225
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Fax |
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Provider Business Mailing Address
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Address Line | 3558 WOODLAWN DR APT A
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City | HONOLULU
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State | HI
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Zip | 96822-1494
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Country | US
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Telephone |
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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 | 106E00000X
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Taxonomy Name | Assistant Behavior Analyst
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT-2513
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License Number State | HI
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