=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376992859
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DEROY THERAPY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/06/2016
-----------------------------------------------------
Last Update Date | 06/06/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 94-1390 KULEWA LOOP #42/U
-----------------------------------------------------
City | WAIPAHU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96797-4390
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-218-7075
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 94-1390 KULEWA LOOP #42/U
-----------------------------------------------------
City | WAIPAHU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96797-4390
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-218-7075
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. RACHEL C DEROY
-----------------------------------------------------
Credential | OTR/L
-----------------------------------------------------
Telephone | 601-218-7075
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 1547
-----------------------------------------------------
License Number State | HI
-----------------------------------------------------