=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265602932
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JUNE KANIHO OTR
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/09/2008
-----------------------------------------------------
Last Update Date | 03/09/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 64-974 MAMALAHOA HWY
-----------------------------------------------------
City | KAMUELA
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96743-7329
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-885-4551
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 63
-----------------------------------------------------
City | KAMUELA
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96743-0063
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-885-4551
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 252
-----------------------------------------------------
License Number State | HI
-----------------------------------------------------