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General NPI Number Information
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NPI Number | 1205183472
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Entity Type | Organization
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Legal Business Name | KUPUKUPU CENTER FOR ARTS AND HEALING LLC
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Dates
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Enumeration Date | 08/07/2012
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Last Update Date | 08/07/2012
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Provider Practice Location Address
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Address Line | 15-2958 PAHOA VILLAGE RD
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City | PAHOA
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State | HI
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Zip | 96778
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Country | US
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Telephone | 808-965-6307
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1864
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City | PAHOA
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State | HI
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Zip | 96778-1864
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Country | US
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Telephone | 808-965-6307
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Fax |
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Authorized Official
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Title or Position | LICENSED MASSAGE THERAPIST
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Name | STEPHANIE JOERKE
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Credential | L.M.T.
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Telephone | 808-965-6307
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State |
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