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General NPI Number Information
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NPI Number | 1174439202
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Entity Type | Individual
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Provider Name | DYLAN KENTA TAKARA OTD
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Gender | Male
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Dates
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Enumeration Date | 08/19/2026
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Last Update Date | 08/19/2026
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Provider Practice Location Address
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Address Line | 45-545 KAMEHAMEHA HWY
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City | KANEOHE
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State | HI
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Zip | 96744-1943
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Country | US
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Telephone | 808-441-7538
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Fax |
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Provider Business Mailing Address
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Address Line | 45-545 KAMEHAMEHA HWY
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City | KANEOHE
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State | HI
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Zip | 96744-1943
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT-2438-0
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License Number State | HI
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