=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255652236
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OT TO YOU LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/14/2010
-----------------------------------------------------
Last Update Date | 06/14/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2957 KALAKAUA AVE APT 201
-----------------------------------------------------
City | HONOLULU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96815-4650
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-347-1969
-----------------------------------------------------
Fax | 808-440-0395
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 4559
-----------------------------------------------------
City | HONOLULU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96812-4559
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-347-1969
-----------------------------------------------------
Fax | 808-440-0395
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OTR
-----------------------------------------------------
Name | MS. HILARY LEE HABERSHAW
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 808-347-1969
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | OT-764
-----------------------------------------------------
License Number State | HI
-----------------------------------------------------